CMS Announces Safeguards for Dual-Eligible Medicare Drug Coverage
CMS on Thursday announced that dual eligibles who are not automatically enrolled in the new Medicare prescription drug benefit or have not selected a plan on their own by Jan. 1, 2006, still will be able to fill their prescriptions at pharmacies, the AP/Barre-Montpelier Times Argus reports. CMS automatically is enrolling about six million U.S. residents who are dually eligible for Medicare and Medicaid in prescription drug plans offered under Medicare.
Some consumer advocates have raised concerns that the federal government could miss some dual eligibles, resulting in a loss of prescription drug coverage beginning Jan. 1, the AP/Times Argus reports. Eight advocacy groups last month filed a lawsuit against the federal government to continue Medicaid coverage for dual eligibles until they are enrolled in a plan that meets all of their medication needs.
According to the announcement made on Thursday, CMS has addressed such concerns by contracting with two companies to ensure that dual eligibles receive necessary prescription drugs if they are not enrolled in a Medicare drug plan by Jan. 1.
Pharmacists dispensing drugs for dual eligibles will be able to check with Maryland-based Z-Tech to determine a customer's eligibility for drug coverage. Z-Tech's contract is worth about $1.6 million.
The pharmacists then will be able to bill Indiana-based WellPoint for the drugs, and the company will enroll any dual eligibles without drug coverage in one of its Medicare drug plans (Freking, AP/Barre-Montpelier Times Argus, 12/1). Wellpoint will manage a single national account for payment of the claims.
Federal officials expect there to be a "limited number" of dual eligibles who do not have Medicare drug coverage by Jan. 1, CQ HealthBeat reports (CQ HealthBeat, 12/1).
CMS spokesperson Gary Karr said WellPoint was chosen to provide the national account because it has a pharmacy network in all 50 states. "They'll be able to leave the pharmacy with their prescription in hand, even if there is not immediate evidence of what plan they're in," CMS Administrator Mark McClellan said (AP/Barre-Montpelier Times Argus, 12/1). He added that the announcement is unrelated to the lawsuit filed by the advocacy groups and that the plan has been under development for months. "It's not a late add-on," McClellan said.
Deanne Beebe, director of communications for the Medicare Rights Center, one of the plaintiffs in the suit, "praised" the plan, CQ HealthBeat reports (CQ HealthBeat, 12/1). However, she said MRC will continue with its suit (AP/Barre-Montpelier Times Argus, 12/1). "We just want to be sure that every dual that walks into a drug store with a prescription to be filled walks out with their medication," she said. Beebe added, "If CMS can foresee all the troubles and find remedies for all of them, that would be terrific" (CQ HealthBeat, 12/1).
Meanwhile, members of Congress on Thursday continued to pressure the Bush administration to extend the deadline for enrollment in the new drug benefit, the Los Angeles Times reports. The enrollment period ends May 15, and beneficiaries who choose to sign up for a plan after that will face financial penalties for each month they delay enrollment.
Rep. Pete Stark (D-Calif.), who has introduced legislation to extend the enrollment period through the end of 2006, said, "My guess is when (Congress) comes back from Thanksgiving recess, they'll be jumping up and down to do something, because they're hearing from a lot of people who are getting heartburn trying to figure this out."
According to the Times, a majority of the Senate in a test vote in November supported extending the deadline and postponing financial penalties.
Dan McLaughlin, a spokesperson for Sen. Bill Nelson (D-Fla.), who led the test vote, said, "I think that vote is reflective of bipartisan support. We intend to push it again in January."
The Bush administration has said it opposes extending the deadline, but organizations working to enroll Medicare beneficiaries said Republican leaders might have to reconsider their stance if beneficiaries continue to resist enrollment.
"We all know there is initial confusion," John Rother, policy director for AARP, said, adding, "What we don't know is whether people will work their way through it."
James Firman -- president and CEO of the National Council on the Aging and chair of the Access to Benefits Coalition, which is leading a grassroots effort to enroll beneficiaries in the new benefit -- said, "You need to get 20 million to 25 million people into the program for it to be successful. If there are only 10 million people enrolled by April, then that would make the case for a longer sign-up period" (Alonso-Zaldivar, Los Angeles Times, 11/2).
In related news, the Christian Science Monitor on Friday included an interview with Douglas Holtz-Eakin, director of the Congressional Budget Office, who is leaving the agency to direct the Center for Geoeconomic Studies at the Council on Foreign Relations. In his interview, Holtz-Eakin addressed a number of issues, including Medicare finances.
He said, "The arithmetic is quite daunting at the moment. We simply cannot make the spending promises add up to the potential receipts, and indeed the spending promises threaten to outstrip even sensible increases in taxes in the United States. ... The Medicare bill is expensive, it was expensive when it passed. ... The question is, is it worth it? And people will disagree on that. But it is hard for me, at least from a health policy perspective, to imagine a modern health program that doesn't include pharmaceuticals. They are an important part of therapy" (Cook, Christian Science Monitor, 12/2).
Additional information about the Medicare drug benefit also is available online.