Groups Say Medicare Drug Plans Too Complex for Some

The Medicare prescription drug benefit helps millions of beneficiaries obtain access to medications, but delays in reimbursements from health insurers and the complexity of the program have led to problems for pharmacies and beneficiaries, experts testified at a Senate Finance Committee hearing on Wednesday, Dow Jones reports.

At the hearing, Timothy Tucker, president-elect of the American Pharmacists Association, said that, under the Medicare prescription drug benefit, pharmacies face unfair negotiation practices by health insurers, low and delayed reimbursements and a lack of transparency on medication prices (Mantell, Dow Jones, 5/2). In addition, pharmacies played a large role in efforts to help Medicare beneficiaries with the complexity of prescription drug plans, Tucker said (Wayne, CQ Today, 5/2).

Tobey Schule, who operates a pharmacy in Montana, said that, although pharmacies can wait more than one month for reimbursements from health insurers, wholesalers request payments every two weeks (Johnson, CongressDaily, 5/2).

Tucker said that health insurers often offer pharmacies "take it or leave it contracts" that require them to accept contracts with Medicare prescription drug plans or lose other business. He added, "Because of the lack of opportunity for pharmacies to negotiate their contracts with Part D plans, pharmacies have been forced into contracts that do not cover their costs. To ensure that Medicare beneficiaries continue to have access to community pharmacies, additional oversight of pharmacy reimbursement must be established" (Dow Jones, 5/2).

Senate Finance Committee Chair Max Baucus (D-Mont.) said he had concerns that "many pharmacies are still having difficulty getting fair and timely compensation from drug plans." Baucus added, "I'm particularly concerned about smaller pharmacies in rural areas. If these pharmacies are forced to close, it will limit access for many seniors" (CQ Today, 5/2).

In addition to problems for pharmacies, Vicki Gottlich, a senior policy attorney with the Center for Medicare Advocacy, testified that the large number of Medicare prescription drug plans "affect the ability of beneficiaries to understand the program, choose plans, pay premiums, benefit appropriately from the low-income subsidy, and utilize the exceptions and appeals process." She added that some analysts have "concluded that having to choose among many options creates a burden" for Medicare beneficiaries and "increases their difficulty in making an informed and meaningful decision" (Dow Jones, 5/2).

Gottlich said, "The number of plans and the number of variables make choice virtually impossible."

Baucus said that Congress might consider legislation to limit the number of Medicare prescription drug plans, adding that CMS "approved more plans than we anticipated." He said, "Let's make it easier" (CQ Today, 5/2).

Baucus added, "We have raised the program through its infancy. Let's learn what we can ... do even better as the program heads into its terrible twos" (Johnson, CongressDaily, 5/2).

Kris Gross, director of the Senior Health Insurance Information Program for the Iowa Insurance Division, testified that a number of Medicare beneficiaries also have had prescription drug benefit premium payments erroneously withheld from Social Security checks.

Gross said, "For some clients, the premium was not withheld as requested; for others, a change in their plan choice was not accurately processed and reflected. The premium errors have resulted in beneficiaries being disenrolled from plans, excess premiums being withheld and premium refunds not reimbursed."

Baucus said that the program to withhold Medicare prescription drug benefit premiums from Social Security checks, which sought to make the payment process less complicated for beneficiaries, "has proven to be an administrative mess" and "is causing real confusion and hardship for many seniors."

The committee next week will meet with officials from CMS, the Social Security Administration and the Government Accountability Office to discuss problems with the Medicare prescription drug benefit (Dow Jones, 5/2).

In related news, SSA this week will launch a campaign to enroll more low-income Medicare beneficiaries in the subsidy program for the prescription drug benefit, USA Today reports.

At least 3.2 million low-income Medicare beneficiaries qualify for, but are not enrolled in, the subsidy program, which eliminates prescription drug plan premiums and reduces copayments for brand-name medications to $5 monthly and generic treatments to $2 monthly.

Obstacles to enrollment in the subsidy program include a complex application process; reliance on telephone calls, letters and forums to raise awareness about the program; and lack of trust in the government among Medicare beneficiaries who qualify for the program. The campaign will target families, caregivers and friends of Medicare beneficiaries who might qualify for the subsidy program with the message, "This Mother's Day, show someone you love how much you care" (Wolf, USA Today, 5/3).