California Healthline Highlights State Actions Related to Medicare Drug Benefit
In addition to California, several other states recently took steps to ensure that Medicare beneficiaries -- including dual eligibles, whose prescription drug coverage was switched from Medicaid to Medicare on Jan. 1 -- are receiving needed medications under the new Medicare prescription drug benefit. Summaries of the actions appear below.
ABCNews' "World News Tonight" on Thursday reported on beneficiaries' difficulties accessing drugs through the Medicare prescription drug benefit. The segment includes comments from Mike Beebe (D), Arkansas attorney general; Jeanne Finberg, directing attorney at the National Senior Citizens Law Center; McClellan; Riley; pharmacists; and Medicare beneficiaries (Hayes, "World News Tonight," ABCNews, 1/12).
Gov. Mike Huckabee (R) on Wednesday declared a public emergency in Arkansas and said the state will cover prescription drug costs for Medicare beneficiaries who are unable to obtain needed medications under the Medicare drug benefit, the Arkansas Democrat-Gazette reports.
Huckabee on Wednesday met with Mark Riley, executive vice president of the Arkansas Pharmacists Association, who said pharmacists had "files several inches thick of claims" that were not being reimbursed by Medicare. Riley said the pharmacies cannot afford to continue giving medications to beneficiaries whose eligibility cannot be verified and likely will stop filling prescriptions next week.
To address the issue, Huckabee said the state will reimburse pharmacies for costs related to the Medicare drug benefit during the first two weeks of January, after which the state will review the situation "continually" to ensure beneficiaries are receiving their drugs. He said the state Department of Health and Human Services will use operating funds to reimburse pharmacists, and he will call a special legislative session to appropriate more if additional funding is needed.
Huckabee said HHS Secretary Mike Leavitt informed him that the problems would be fixed "in a matter of days."
Meanwhile, Rep. Marion Berry (D-Ark.) has asked President Bush to declare a nationwide emergency related to the new drug benefit, saying that if Bush does not call for new funding to reimburse states for costs related to the benefit he will introduce a bill in the House Appropriations Committee to do so (Bleed, Arkansas Democrat-Gazette, 1/12).
The state on Wednesday launched a plan to pay for prescription drugs for dual eligibles who have been unable to obtain medications under Medicare. Pharmacists will be able to bill the state directly for prescription drugs given to a beneficiary if Medicare's system denies payment.
The plan will assess each beneficiary's need individually, and officials expect program expenses to be small because the state will recover costs from private Medicare prescription drug plans. The state aid will continue until Medicare officials have addressed the problems with the Medicare system, Anne Marie Murphy, chief of Illinois' Medicaid program, said.
According to the Chicago Tribune, both dual eligibles and beneficiaries of Illinois Cares Rx -- an existing state pharmaceutical assistance program that is supposed to pay expenses that private Medicare plans do not cover -- will be able to participate in the temporary program. Many beneficiaries in Illinois Cares Rx are being charged full deductibles, premiums and copayments under the Medicare drug benefit, despite a regulation that requires Illinois Cares Rx to cover such expenses (Graham, Chicago Tribune, 1/12).
State officials have established a program to help Medicare beneficiaries "navigate the maze" of the Medicare drug benefit, and Senior Rx -- the state's prescription drug assistance program for low-income seniors -- has established a one-month transition program to help beneficiaries obtain medications under Medicare, the Las Vegas Sun reports. In addition, the Nevada Division of Mental Health and Developmental Disabilities is distributing free samples of prescription drugs to beneficiaries who cannot obtain their medications.
Charles Duarte, administrator of the state Division of Health Care, Financing and Policy, said Nevada will decide by the end of the week whether to provide additional financial aid to dual eligibles, a move that would cost an estimated $6 million for one month (Ryan, Las Vegas Sun, 1/12).
Sen. Hillary Rodham Clinton (D-N.Y.) on Thursday asked New York Gov. George Pataki (R) to authorize a temporary program to assist Medicare beneficiaries who could not obtain needed medications.
State officials said existing prescription drug programs should guarantee that pharmacists will be paid, Long Island Newsday reports.
Pataki spokesperson Andrew Rush said, "New York is already working to ensure that those who qualify for both Medicare and Medicaid continue to have access to the prescription drugs they need" (Thrush, Long Island Newsday, 1/13).
NPR's "All Things Considered" on Wednesday included an interview with Gov. John Hoeven (R) about steps he has taken to ensure that Medicare beneficiaries are receiving needed medications under the new Medicare prescription drug benefit. According to Hoeven, the state will provide funding until Jan. 23 for prescription drugs for dual eligibles in the state who are unable to obtain their medications under Medicare.
In addition, Medicare beneficiaries who are experiencing difficulty may call volunteers from North Dakota's Senior Health Insurance Counseling Program for assistance with enrollment and determining prescription drug eligibility (Norris, "All Things Considered," NPR, 1/11). The complete segment is available online in RealPlayer.
State officials on Thursday announced plans to help some dual eligibles with drug costs under the Medicare drug benefit, the Pittsburgh Post-Gazette reports (Snowbeck/Fahy, Pittsburgh Post-Gazette, 1/13). Beginning on Friday, pharmacies will be allowed to bill the state directly when dual eligibles are incorrectly asked to pay more than a $1 to $5 copayment for their medications.
According to Gov. Ed Rendell (D), some beneficiaries mistakenly were being charged as much as $250 for their medications. Beneficiaries who overpaid can return to the pharmacy and be reimbursed for the overpayment.
According to the Philadelphia Inquirer, the plan "stops short" of other states' plans because it aids only those who are already in the Medicare database or in a Medicare prescription drug plan. Beneficiaries whose eligibility cannot be verified will not be helped.
The plan to cover the incorrect copays will cost the state about $2 million, James Hardy, acting deputy secretary of the state's Office of Medical Assistance Programs, said (Sullivan, Philadelphia Inquirer, 1/13).
Gov. Don Carcieri (R) on Wednesday issued an executive order to create a temporary program to help dual eligibles obtain needed medications. Effective Thursday morning, Rhode Island reactivated its Medicaid prescription drug coverage for all 27,000 dual eligibles.
Under the plan, if a dual eligible's prescription is rejected by Medicare or the beneficiary's plan requests a copayment that is higher than the required $1 for generic drugs and $3 for brand-name drugs, the pharmacists should bill the state Medicaid program for the cost, the Providence Journal reports.
Jane Hayward, managing director of Carcieri's Office of Health and Human Services, said the state cannot estimate the cost of providing the temporary coverage because it is unclear how many dual eligibles have been unable to obtain medications under the new Medicare benefit. She noted that the total monthly cost for prescription drug coverage for all dual eligibles is about $7.5 million, but she estimated that no more than 10% of the total dual eligible population has had difficulty obtaining medications (Freyer, Providence Journal, 1/12).
CMS spokesperson Gary Karr said, "It's unacceptable if any beneficiaries are not getting their prescriptions. We are working with states to solve the problem." He added that problems seemed to be primarily among a group of low-income beneficiaries who changed from one prescription drug plan to another last month (Pear, New York Times, 1/13).
CMS Administrator Mark McClellan said that his agency is "working around the clock" to address the problems (Chicago Tribune, 1/12).
Sen. Frank Lautenberg (D-N.J.) said he will introduce legislation requiring CMS to reimburse states for costs related to providing temporary drug coverage to dual eligibles (Reichard, CQ HealthBeat, 1/12).
However, McClellan said CMS does not have the authority to reimburse states.
Meanwhile, Sen. Max Baucus (D-Mont.) on Thursday sent a letter to HHS Secretary Mike Leavitt saying he is "disappointed and extremely concerned" with the transition of dual eligibles from Medicaid to Medicare and called on CMS to "improve its information technology systems to speed beneficiary enrollment in the drug benefit and electronic verification of that enrollment for pharmacists" (Carey, CQ HealthBeat, 1/12).
According to the New York Times, several other states -- including Connecticut, Hawaii, Maine, Massachusetts, New Hampshire, New Jersey, South Dakota and Vermont -- also have taken action to address problems with beneficiaries obtaining medication under the Medicare drug benefit (New York Times, 1/13).