Low-Income Seniors Not Getting Drug Subsidy
About 24% of the 7.2 million Medicare beneficiaries who are thought to be eligible for a low-income subsidy under the Medicare prescription drug benefit have been approved for the assistance, according to a report released on Tuesday by Families USA, USA Today reports. The subsidy, which qualifies beneficiaries for copayments as low as $1 to $5 per prescription, is available to individuals with annual incomes below $15,000 and assets under $11,500, not including their homes (Wolf, USA Today, 5/9).
According to the Families USA report, about 1.7 million beneficiaries currently are receiving the subsidy (Carey [1], CQ HealthBeat, 5/8). Participation rates range from 12% in Arizona to 41% in Kentucky, the report finds (Wolf, USA Today, 5/9).
Enrollment in the subsidy program has exceeded one-third of those eligible in six states: Arkansas, Delaware, Kentucky, North Carolina, Texas and Vermont, according to the report.
The report also looks at the quality of drug coverage for dual eligibles. According to the report, dual eligibles received better drug coverage under Medicaid than they do now under the Medicare drug benefit.
"They are now in a system with a confusing array of private plan formularies and utilization management rules," the report says (Carey [1], CQ HealthBeat, 5/8).
The report is available online. Note: You must have Adobe Acrobat Reader to view the report.
On Monday, CMS Administrator Mark McClellan urged beneficiaries who have not yet signed up for the drug benefit to do so before the May 15 enrollment deadline, the Pittsburgh Post-Gazette reports. He said, "My message is a basic one: Time is running out."
McClellan added, "Enroll now, start saving and avoid the last-minute rush" (Fahy/Snowbeck, Pittsburgh Post-Gazette, 5/9). McClellan said that Medicare is not experiencing problems with its Web site or phone lines as it did during the initial weeks of the program.
"We're getting more calls, several hundred thousand a day, and the Web site is still operating under 20% of our server's capacity," McClellan said (Merx, Detroit Free Press, 5/9).
Enrollment has remained steady at about 400,000 new enrollees per week, CMS said (Rubenstein, Wall Street Journal, 5/9). The Washington Post on Tuesday profiled several beneficiaries and assessed their experiences with the drug benefit (Gearon, Washington Post, 5/9).
House Ways and Means Health Subcommittee Chair Nancy Johnson (R-Conn.) and House Republicans this week are expected to propose a resolution encouraging beneficiaries to sign up for the drug benefit. Meanwhile, Democrats and some advocacy groups continue to call for an extension of the deadline.
On Monday, Rep. Marion Berry (D-Ark.), Americans United and the Institute for America's Future said the deadline should be extended because beneficiaries are confused about the program. However, Berry said congressional action on the matter is "about as likely as me going to the moon by Monday."
Meanwhile, a Congressional Budget Office report released on Monday finds that extending the deadline for enrolling in the drug benefit would cost the government $100 million this year and $3.4 billion over 10 years, largely because the government would not be collecting late-enrollment penalties (May, CongressDaily, 5/9).
Beneficiaries who sign up after the deadline will have to pay a 1% increase in their premiums for each month enrollment is delayed. The next enrollment period begins in November, meaning beneficiaries who miss next week's deadline will have to pay at least 7% higher premiums (California Healthline, 5/9).
The report estimates that about 10 million beneficiaries who are eligible to enroll in the drug benefit this year will sign up over the next three years. If the deadline were extended to Dec. 31, about one million of those beneficiaries would enroll this year, the report says (Washington Post, 5/9).
The report is available online. Note: You must have Adobe Acrobat Reader to view the report.
In related news, USA Today on Monday examined how Republican and Democratic strategists "agree" the new drug benefit "is going to be an important campaign issue" but are not "entirely certain" what the impact of the benefit will be on voting preferences (Page, USA Today, 5/9).
According to a USA Today/CNN/Gallup Poll released Tuesday, 54% of U.S. adults think the drug benefit is not working, while 27% think it is working. However, 53% of adults age 65 and older say they are "more likely" to vote for a member of Congress who supported the drug benefit, compared with 34% who say they are "less likely" to vote for such a lawmaker (Lewis, USA Today chart, 5/9).
Sen. Debbie Stabenow (D-Mich.) said, "From every angle, this has been a disaster," adding that she has received "repeated complaints about the complexity" of the program. However, Rep. Tom Reynolds (R-N.Y.), chair of the Republican congressional campaign committee, said the drug benefit ultimately will be "nothing but a positive" (Page, USA Today, 5/9).
Still, some policy experts questioned how much the drug benefit will influence the November elections, the Post-Gazette reports (Pittsburgh Post-Gazette, 5/9).
Senate Finance Committee Chair Chuck Grassley (R-Iowa) and ranking Democrat Max Baucus (D-Mont.) invited the CEOs of AstraZeneca, Pfizer and Merck, as well as Pharmaceutical Research and Manufacturers of America President Billy Tauzin, to attend a closed-door session on May 11 to discuss the pharmaceutical companies' patient assistance programs, CQ HealthBeat reports (Carey [2], CQ HealthBeat, 5/8).
Some pharmaceutical companies had said they would end their PAPs because they were concerned that the programs could violate federal anti-kickback laws that prohibit drug makers from steering beneficiaries toward their own products. The companies cited a guidance document issued by HHS Inspector General Daniel Levinson in November 2005 that said PAPs potentially could be considered unlawful if, for example, drug makers arranged to pay for a beneficiary's prescriptions during the so called "doughnut hole" in Medicare coverage only if the beneficiary agreed to use the manufacturer's product. However, Levinson in April issued a new advisory opinion in which he clarified that pharmaceutical companies can legally operate PAPs that meet certain specifications (American Health Line, 5/3).
Grassley, Finance Subcommittee on Health Care Chair Orrin Hatch (R-Utah) and subcommittee ranking member John Rockefeller (D-W.Va.) said Levinson's clarification showed that PAPs can operate under the drug benefit without violating federal anti-kickback laws.
PhRMA Senior Vice President Ken Johnson said Tauzin will attend the session, adding, "Clearly, we want to be as helpful as possible, but because of antitrust issues each company must make its own decisions with respect to helping seniors with the [PAPs]" (Carey [2], CQ HealthBeat, 5/8).
PBS' "NewsHour with Jim Lehrer" on Monday reported on the upcoming deadline for enrollment in the Medicare prescription drug benefit.
The segment includes comments from James Firman, president and CEO of the National Council on Aging; Joshua Klein, education fellow with the Medicare Rights Center; CMS Administrator Mark McClellan; pharmacists; Medicare enrollment counselors; and Medicare beneficiaries (Dentzer, "NewsHour with Jim Lehrer," PBS, 5/8).
The complete segment is available online in RealPlayer.
In addition, C-SPAN's "Washington Journal" on Tuesday included a discussion with CMS Deputy Administrator Leslie Norwalk ("Washington Journal," C-SPAN, 5/9). The complete segment will be available online in RealPlayer and Windows Media after the broadcast.
McClellan is scheduled to answer questions about Medicare in an "Ask the White House" chat on Wednesday at 3 p.m. ET. A transcript of the chat will be available online.