Low-Income Beneficiaries Targeted for Drug Benefit Enrollment

The Bush administration is undertaking a new effort to locate and enroll many of the estimated four million low-income Medicare beneficiaries not signed up for the Medicare prescription drug benefit, USA Today reports.

Beneficiaries with annual incomes below about $15,000 and assets below $11,500, not including homes, qualify for government-subsidized premiums and copayments under the drug benefit. About 38.7 million of the 42.5 million Medicare beneficiaries have some form of prescription drug coverage, but the majority of those without coverage -- about three million beneficiaries -- are eligible for the low-income subsidy, according to the Bush administration.

As part of the new enrollment effort, the Social Security Administration will mail 500,000 applications to several different groups of seniors ages 79 and older -- including low-income seniors, beneficiaries with disabilities, those in low-income neighborhoods, Hispanics and those who do not handle their own financial affairs. The enrollment deadline for most beneficiaries was May 15, but the government is allowing low-income beneficiaries to sign up for the drug benefit at any time.

The new enrollment drive is "the latest in a series of attempts by the government and private groups to lure those seniors who stand to benefit the most" from the program, "but who are most likely to have missed out on the coverage," USA Today reports (Wolf, USA Today, 6/12).

A coalition of 30 health care groups, including the National Center for Assisted Living and the American Health Care Association, have sent a letter to Sen. Gordon Smith (R-Ore.) expressing support for a bill (S 2409) that would eliminate copays under the drug benefit for dual eligibles who reside in certain assisted living facilities, CQ HealthBeat reports. Under the bill, which was sponsored by Gordon, prescription drug copays would be eliminated for dual eligibles who live in assisted living facilities, resident care program facilities or other similarly licensed programs. Nursing home residents already are exempted from copays.

According to the letter, there are 121,000 dual eligibles in assisted-living and residential care facilities who "have very limited financial resources, often just a few dollars a month from a personal needs allowance." The letter adds, "For many of these residents, the amount of their Part D copayments exceeds their monthly personal needs allowances" (Hopkins, CQ HealthBeat, 6/9).

The House Ways and Means Committee on Wednesday will hold a hearing on the implementation of the Medicare drug benefit, CongressDaily reports. Committee Chair Bill Thomas (R-Calif.) plans to use the hearing to look at "who signed up for the program, who did not and why," according to CongressDaily.

House Majority Leader John Boehner (R-Ohio) has said he will wait until after the committee reviews enrollment numbers to decide whether the chamber should take up legislation that would eliminate the late-enrollment penalty for beneficiaries who missed the May 15 deadline (CongressDaily, 6/12).

The New York Times on Sunday examined the effects of the Medicare drug benefit on beneficiaries, pharmacists and doctors in McAllen, Texas, a town near the Mexican border in the Rio Grande Valley. According to the Times, beneficiaries in the town are "hav[ing] difficulty getting the drugs they need" and pharmacists and doctors "are struggling to figure out which drugs are covered by which plans."

In addition, pharmacists are "swamped with questions and complaints from beneficiaries" and "have run into many practical problems as they try to navigate a complex program administered by dozens of prescription drug plans, each with its own policies and procedures," the Times reports (Pear, New York Times, 6/11).

"Buying drug coverage ... is not like buying a television," Diane Archer, founder of the Medicare Rights Center, writes in a letter to the editor of the New York Times in response to a recent editorial on the drug benefit. "With drug coverage, you cannot predict your future needs," Archer writes, adding, "Worse still, the Part D private drug plans are allowed to change the drugs they cover and the prices they charge at any time, rendering informed consumer choice meaningless."

She concludes that beneficiaries "deserve a drug benefit that meets their needs now and in the future, and at a predicable cost directly through traditional Medicare" (Archer, New York Times, 6/11).

NPR's "All Things Considered" on Saturday reported on pharmacists' claims that payments from pharmacy benefit managers under the Medicare prescription drug benefit are too slow and too small for community pharmacies to cover their expenses. The segment includes comments from Mike James, owner of Person Street Pharmacy in Raleigh, N.C.; Mark Merritt, president of the Pharmaceutical Care Management Association; and Edward Scaff, a former pharmacy owner in Evergreen, Colo. who now operates a liquor store because it was no longer profitable to sell medications (Rovner, "All Things Considered," NPR, 6/10).

The complete segment is available online in RealPlayer.