Emergency Drug Coverage for Dual Eligibles Extended
Gov. Arnold Schwarzenegger (R) authorized a 15-day extension of emergency prescription drug coverage for residents who are dually eligible for Medicare and Medi-Cal and are having problems obtaining medications under the Medicare drug benefit, the Modesto Bee reports. The emergency coverage was set to expire on Friday, but the extension will provide coverage through Feb 11.
As of Wednesday, the Health and Human Services Agency had paid for more than 141,000 prescriptions at a cost of $11.4 million (Carlson, Modesto Bee, 1/27).
Stan Rosenstein, deputy director of medical services for Medi-Cal, said the state has been paying for about 11,000 to 12,000 prescriptions daily (Jablon, AP/San Jose Mercury News, 1/26). According to Rosenstein, California is paying for about 16% to 17% of the prescriptions the state previously paid for before the Medicare drug benefit was implemented.
HHSA Secretary Kim Belshe said the error rate for determining coverage appears to be declining (Goldeen, Stockton Record, 1/27). However, she said it is too soon to tell whether problems with the program will be resolved over the next two weeks (Modesto Bee, 1/27).
Summaries of recent actions in three other states appear below.
- Florida: The state will pay for prescription drugs for an estimated 100,000 dual eligibles who have been unable to obtain needed medications under the new Medicare drug benefit, Gov. Jeb Bush (R) announced on Thursday (Clark/Caputo, Miami Herald, 1/27). Many dual eligibles in Florida have had difficulty obtaining prescription drugs under the Medicare benefit because pharmacists have been unable to verify their enrollment or private plans mistakenly have charged them high copayments. To address such problems, Florida will pay for prescription drugs for affected seniors through Feb. 15, Bush said. The state expects to spend up to $21 million on the coverage in the next three weeks (Shelton, Orlando Sentinel, 1/27). If the federal government has not fixed the problems at the end of two weeks, Bush by executive order will extend the supplemental help at a cost of $37 million per month, according to the Miami Herald. The state expects to be reimbursed for the costs of the program (Miami Herald, 1/27).
- New York: Low-income seniors in New York who currently have prescription drug coverage under the state's Elderly Pharmaceutical Insurance Coverage plan could be switched to a Medicare drug plan by mid-summer under a state budget proposal, Long Island Newsday reports. EPIC provides discounted drugs to seniors with annual incomes too high to qualify for Medicaid. Under the proposal, an estimated 91,000 EPIC beneficiaries who qualify for Medicare would have to enroll in a Medicare prescription drug plan by July 1. EPIC would continue to provide a "wrap-around" benefit to seniors in case some drugs are not covered by their plan, according to Newsday. Another 45,000 EPIC beneficiaries are expected to enroll in a Medicare drug plan voluntarily. The switch would save the state an estimated $113 million in fiscal year 2007 (Luhby, Long Island Newsday, 1/26).
- Texas: Texas officials announced on Wednesday that the state will cover prescription drug costs for about 320,000 dual eligibles who have had difficulty obtaining medications under the new Medicare drug benefit, the Dallas Morning News reports. After receiving word from the federal government that states will be reimbursed for providing such coverage, state Health and Human Services Commissioner Albert Hawkins announced that Texas pharmacists should fill prescriptions for dual eligibles who are unable to obtain their medications and bill the state for the costs. Texas joins 25 other states and Washington, D.C., in offering the temporary coverage (Garrett, Dallas Morning News, 1/25).