CMS Launching ‘Final Push’ for Drug Benefit Enrollment

Medicare has added 6,000 telephone operators, quadrupled its computer enrollment capacity and promised to participate in more than 1,000 events in the next week as part of a "final push" to enroll Medicare beneficiaries in the prescription drug benefit before the May 15 sign up deadline, the AP/San Francisco Chronicle reports (Freking, AP/San Francisco Chronicle, 5/7).

Beneficiaries who sign up after the deadline will have to pay a 1% increase in their premiums for each month enrollment is delayed. The next enrollment period begins in November, meaning beneficiaries who miss next week's deadline will have to pay at least 7% higher premiums, the Philadelphia Inquirer reports.

Bush administration officials have said certain groups -- including low-income beneficiaries, those with special needs and some Hurricane Katrina evacuees -- will not be penalized for late enrollment (Sullivan, Philadelphia Inquirer, 5/8).

HHS Secretary Mike Leavitt said an estimated 38 million Medicare beneficiaries now have some type of prescription drug coverage. He added that officials have "got a shot at getting to 90%" of the 43 million beneficiaries who are eligible for drug coverage through various programs.

Leavitt said the May 15 deadline will not be extended, adding that for those who have not yet enrolled, "the reason they have chosen not to sign up will probably be as true in June or July as it is today." He said there are four groups of beneficiaries who have not enrolled: those who have no drug expenses and "don't think they need a plan," those who think the drug benefit is only available to low-income beneficiaries, people who have procrastinated, and those who do not wish to sign up for a government program (AP/San Francisco Chronicle, 5/7).

A group of "several hundred" activists from National People's Action, a coalition of advocacy groups, on Sunday demonstrated in front of Leavitt's home in Arlington County, Va., to protest the enrollment deadline, the Washington Post reports. The protestors called for an extension of the deadline to December 31.

HHS spokesperson Bill Hall said Leavitt is out of town this week and will not meet with National People's Action. Hall reiterated that Leavitt does not plan to extend the deadline (Thompson, Washington Post, 5/8).

Two other newspapers on Sunday also published articles related to the drug benefit and the enrollment deadline. Summaries appear below.

• Baltimore Sun: The Sun published a question-and-answer feature on the drug benefit for beneficiaries who have not yet enrolled. The article answers questions on eligibility requirements, alternative sources of drug coverage, drug plan options and other topics (Salganik, Baltimore Sun, 5/7).
  
  
• Los Angeles Times: The Times examined how the late-enrollment penalty "is one of the least-understood aspects" of the drug benefit. The penalty equals 1% of the national average monthly premium multiplied by the number of months since June 1, which is the effective date of coverage for beneficiaries who enroll by May 15. The penalty continues to increase with time, meaning a beneficiary who is eligible to enroll now but waits to sign up until the end of 2009 would have to pay an increase of 43% of the average monthly premium, according to the Times (Alonso-Zaldivar [1], Los Angeles Times, 5/7).
  
  
• Los Angeles Times: The Times also examined how the drug benefit "apparently is achieving its primary objective: helping millions of Americans get protection they did not previously have against one of the most draining problems of growing older." However, the enrollment process "remains so complex and hard for seniors to navigate" that it has prevented the program from "being hailed as an unqualified success," the Times reports (Alonso-Zaldivar [2], Los Angeles Times, 5/7).

In related news, Democratic leaders say that if their party wins majority control of the House in the November election, they would repeal a provision in the 2003 Medicare law that prevents HHS from negotiating Medicare drug prices with pharmaceutical companies, the Washington Post reports. According to the Post, Democrats are "increasingly confident they will seize control of the House in November," but many analysts still consider it a "long shot" that Democrats will pick up the 15 seats they need to gain the majority (Weisman, Washington Post, 5/7).

Meanwhile, CMS has overturned a previous directive and said that Medicare drug plans can cover prescription niacin medication, including Niaspan and Niacor, which are used to treat high cholesterol, Long Island Newsday reports.

CMS officials originally said the treatments were vitamin supplements and thus would not be covered under the drug benefit. They later said the medications would be covered until June after beneficiaries complained that they had not been given 60-day notice of the change.

The American Pharmacists Association and some members of Congress also criticized the exclusion. On April 11, CMS said it had reviewed the issue and determined that niacin medications are not vitamins. Drug plans can add the products to their formularies this year or next year (Friedman, Long Island Newsday, 5/7).