Democrats Outline Proposed Changes to Medicare Drug Benefit
Some House and Senate Democrats on Wednesday proposed several legislative changes to the Medicare prescription drug benefit that they said would ensure beneficiaries could obtain medications with fewer problems, CQ HealthBeat reports. Speaking at a press conference in Washington, D.C., Rep. John Dingell (D-Mich.) and Sens. Richard Durbin (D-Ill.) and Debbie Stabenow (D-Mich.) said Democrats will hold "hundreds" of meetings with beneficiaries across the U.S. to highlight problems with the drug benefit and explain how they would amend the program (Reichard, CQ HealthBeat, 2/15).
Durbin said Democrats are looking for a Senate bill to which they can attach the proposed changes (Chayes, Chicago Tribune, 2/16).
The Democrats propose that Medicare drug plans be required to provide beneficiaries with a 60-day supply of any drug that is not covered by the plan. Plans also would be required to provide a 60-day supply of medication when a pharmacist cannot confirm a beneficiary's enrollment in a Medicare drug plan.
In addition, the proposed legislation would create a standardized appeals process, with medications provided during the appeal (CQ HealthBeat, 2/15). The legislation would prohibit drug plans from eliminating medications from a formulary once a beneficiary has enrolled or "from raising the cost of the drugs in midyear," according to the Tribune (Chicago Tribune, 2/16).
Beneficiaries could change drug plans if a plan did not cover needed medications. The proposals also would require Medicare to reimburse family members, charity organizations and states that covered the costs of medications for beneficiaries unable to obtain drugs because of administrative problems with the drug benefit, and pharmacists could bill Medicare directly for prescription costs for beneficiaries whose enrollment could not be confirmed because of administrative issues (CQ HealthBeat, 2/15).
Durbin said, "We think that we can come together, even on a bipartisan basis, to make this program work for the people across this country." He said the drug benefit "has become a costly, complicated mess that wastes tens of billions of dollars in handouts to pharmaceutical companies and insurance companies."
Stabenow said, "This isn't a political issue. We're talking about whether people get medicine that will save their life."
In a speech on Wednesday in Dublin, Ohio, President Bush said legislative changes to the drug benefit are unnecessary. "When you have that big a shift, you can imagine there's going to be glitches," Bush said, adding, "But, by far, the vast majority of people are signing up to a program that's making a big difference in their lives" (Chicago Tribune, 2/16).
In related news, members of the House Energy and Commerce Committee on Wednesday questioned HHS Secretary Mike Leavitt about the drug benefit, CongressDaily reports (CongressDaily, 2/16). Leavitt said problems with the drug benefit can be corrected through administrative action (CQ HealthBeat, 2/15).
However, Leavitt added that he would work with Congress to address issues with the drug benefit, including concerns about the May 15 enrollment deadline. He said the deadline would encourage beneficiaries to enroll in the drug benefit. "If we do (enrollment) indefinitely, people will not feel the need to investigate this," he said (CongressDaily, 2/16).
Committee Chair Joe Barton (R-Texas) said, "Some sense political advantage in condemning the [drug benefit] and can't bring themselves to admit that free markets actually work." Barton said there have been problems with the drug benefit but added that "critics have tried to make patients believe that they are not smart enough to understand the new Medicare drug benefit, that it provides inadequate coverage and that signing up isn't worth their time because it cannot save them any money. The critics are simply wrong." Barton told Leavitt that the committee will hold "the first of what will likely be several hearings" on the drug benefit on March 1 (CQ HealthBeat, 2/15).
In other Medicare news, U.S. Comptroller General David Walker, head of the Government Accountability Office, told members of the House Budget Committee that the drug benefit should be re-examined as part of a larger restructuring of the way the federal government spends money on health care programs, the Washington Times reports.
Walker suggested increasing the focus on disease prevention, mandating a limited growth rate for government-sponsored health care programs, developing a base of essential health care services and requiring payments for extra services, according to the Times. After outlining his overall recommendations, Walker said, "I would add to that ... relooking at Medicare Part D." Walker said the federal government would have to invest $8.7 trillion in today's dollars to pay for the drug benefit program over the next 70 years or more. He said the costs could be reduced if Medicare was authorized to negotiate drug prices with pharmaceutical companies, a strategy used by the Department of Veterans Affairs.
However, Douglas Holtz-Eakin, an economist at the Council on Foreign Relations and former director of the Congressional Budget Office, said negotiating with pharmaceutical companies would not save much money for Medicare because it serves a different population than the VA. Holtz-Eakin said the drug benefit should remain unchanged. "It's a couple of months old," he said, adding, "It's going to take awhile for this to shake out" (Fagan, Washington Times, 2/16).
The National Mental Health Association, the Epilepsy Foundation, Paralyzed Veterans of America and United Cerebral Palsy on Wednesday called for immediate changes in the drug benefit that would guarantee prompt reimbursement to beneficiaries who have been overcharged for copayments and pharmacists who have covered the cost of medications for beneficiaries because of problems with the drug benefit, the Los Angeles Times reports. In addition, the groups said Medicare should standardize forms and procedural requirements.
Kirsten Beronio of NMHA said, "In general, (Medicare) has been addressing problems on a case-by-case basis, instead of treating them as the systematic problems that they are."
Jeff Kelman, chief medical officer at CMS, said the agency has "made a lot of effort to work with the disability groups and the mental health groups, because they represent a very vulnerable and important population to bring into the benefit." He added, "If we can get a more standardized and simplified process, it will be much easier. That is the direction we're heading in" (Alonso-Zaldivar, Los Angeles Times, 2/16).
APM's "Marketplace" on Wednesday reported on Medicare. The segment includes comments from Medicare Rights Center President Robert Hayes and Jim Hardy, deputy secretary of the Pennsylvania Medical Assistance Program (Scott, "Marketplace," APM, 2/15). The complete segment is available online in RealPlayer.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.