CMS Takes Steps To Ensure Prescription Drug Coverage for Dual Eligibles
CMS Administrator Mark McClellan on Tuesday in a speech to state Medicaid directors addressed concerns that dual eligibles -- individuals who qualify for both Medicare and Medicaid -- will "fall between the cracks" when their prescription drug coverage switches from Medicaid to Medicare, CQ HealthBeat reports.
According to McClellan, CMS is automatically enrolling dual eligibles in a Medicare drug plan to prevent beneficiaries from being denied medications because they have not selected a plan.
CMS has identified 6,130,120 dual eligibles and has assigned 5,498,604 of them to randomly chosen Medicare prescription drug plans, CQ HealthBeat reports. Beneficiaries randomly assigned to plans were mailed letters informing them of their new coverage.
Such beneficiaries are permitted to switch to other plans. In addition, CMS said pharmacists can file eligibility inquiries to determine a beneficiary's coverage if dual eligibles do not know their drug plan.
CMS also has developed a "point of sale mechanism" to ensure coverage if there is a lag time when a beneficiary first is assigned to a plan or "switches in and out of dual eligibility," CQ HealthBeat reports. Under the mechanism, CMS contractors immediately can confirm whether beneficiaries are eligible and arrange to enroll them in a plan (CQ HealthBeat, 11/8).
Additional information about the Medicare drug benefit also is available online.