CMS Releases Complaint Data for Drug Benefit
CMS in June received about 2.3 complaints related to the Medicare prescription drug benefit for every 1,000 beneficiaries enrolled in Medicare drug plans, according to data released by the agency on Wednesday, CQ HealthBeat reports. The agency received about 2.6 complaints per 1,000 beneficiaries enrolled in stand-alone prescription drug plans and about 1.4 complaints per 1,000 beneficiaries enrolled in Medicare Advantage plans, the data show.
CMS divided complaints in four categories:
- Benefits and access;
- Enrollment and disenrollment;
- Pricing and co-insurance; and
In addition, "[v]ery few beneficiary complaints involve other issues like problems with the exceptions or appeals process," CMS said (CMS release, 7/19). CMS said the data will be used to find plans' problems and to address problems in customer service.
Plans with high complaint rates that do not improve over the next month could face fines or restrictions on their enrollment abilities, CMS Administrator Mark McClellan said (CQ HealthBeat, 7/19).
HHS Secretary Mike Leavitt said, "The relatively low number of complaints that we are receiving from beneficiaries is another indication that the vast majority of beneficiaries are getting a high level of service," adding, "While this is an important result, we are making sure that complaints and any underlying problems are being addressed and resolved as quickly as possible" (Hundley, St. Petersburg Times, 7/20).
Rep. Pete Stark (D-Calif.) said the data "cannot mask the Medicare prescription drug program's serious shortcomings," adding, "Even accepting the agency's numbers, an average rate of 2.3 complaints per 1,000 beneficiaries translates into nearly 30,000 people dissatisfied."
Karen Ignagni, president and CEO of America's Health Insurance Plans, said the data "validate the fact that (beneficiaries') experiences are positive." She added, "This is a solid baseline going forward" (CQ HealthBeat, 7/19).
Complete CMS data on complaint rates for beneficiaries enrolled in Medicare Advantage plans is available online.
Complete data on complaint rates for beneficiaries enrolled in PDPs also is available online. Note: You must have Adobe Acrobat Reader to view the charts.
At least 77,000 Medicare beneficiaries in upstate New York will reach the doughnut hole gap in coverage in the Medicare drug benefit this year, Sen. Chuck Schumer (D-N.Y.) said on Wednesday, the Associated Press reports.
Under the doughnut hole provision, beneficiaries are responsible for 100% of total prescription drug costs between $2,250 and $5,100. Medicare then covers 95% of prescription drug costs beyond $5,100.
Schumer's estimates are based on data from the Kaiser Family Foundation and CMS (Choi, Associated Press, 7/19).
Schumer projected that beneficiaries would begin reaching the doughnut hole in late summer or early fall. "This doughnut hole is going to hit upstate New York seniors like a ton of bricks," he said, adding, "Seniors should not have the rug pulled out from under them when they are struggling to pay for the rising cost of prescription drugs" (Kelly/Wheeler, Gannett/Rochester Democrat & Chronicle, 7/20).
Schumer said health insurers should provide less expensive options to help beneficiaries avoid the doughnut hole.
According to the Associated Press, Schumer has proposed legislation that would eliminate premiums for beneficiaries who fall into the doughnut hole and would phase out the doughnut hole over time.
CMS spokesperson Jeffrey Hall said beneficiaries who reach the doughnut hole can reduce costs by using generic medications or switching to less expensive brands when possible (Associated Press, 7/19).