Medicare Drug Benefit Insurers Limited for 2007
Private health insurers sponsoring Medicare prescription drug plans will be allowed to offer no more than two plans next year, CMS Administrator Mark McClellan said on Monday, the Wall Street Journal reports.
Insurers were allowed to offer three plans this year, but some beneficiaries have been overwhelmed by the number of choices, McClellan said. He said the two-plan limit should help simplify the drug benefit. "Two plans should be sufficient," he said.
However, some insurers offering plans that fill coverage gaps in the drug benefit might be allowed to offer three plans, McClellan said (Wall Street Journal, 4/4).
In other drug benefit news, a pharmacist in Menlo Park, Calif., said Monday that he will no longer participate in the program because low reimbursements and payment delays have caused him to lose too much money, CQ HealthBeat reports.
Richard Burge, CEO of Baneth's Pharmacy, said he has accumulated $75,000 in debt because he continued to fill prescriptions for beneficiaries while reimbursements from MedImpact -- the pharmacy benefit manager that administers both plans he accepts -- were reduced or delayed.
Burge accepted beneficiaries from Medi-Cal and Care Advantage, a Medicare drug plan. He said he lost about $7 for every brand-name drug he distributed and even more for generic medications.
The Pharmaceutical Care Management Association, which represents PBMs, said in a statement, "Job No. 1 in Part D for Medicare drug plans, drugstores and other stakeholders is to save money for seniors and make sure they have access to the drugs seniors need. On that score, we are making significant progress."
CMS spokesperson Peter Ashkenaz said agency officials are "sorry to see when a pharmacist has to make a business decision to leave the program."
In related news, the Medicare Rx Education Network on Monday released a survey finding that 87% of beneficiaries who voluntarily enrolled in the drug benefit feel the program works well, CQ HealthBeat reports. About half of beneficiaries actively looking to enroll in a plan say they do not have enough information to chose, while almost 60% of beneficiaries who have not enrolled say choosing a plan is difficult (Carey, CQ HealthBeat, 4/3).
Two surveys from America's Health Insurance Plans show that "[e]ven with the myriad prescription drug plans open to beneficiaries ... seniors are not overburdened by choice," a Washington Times editorial states. According to the surveys, the "vast majority" of beneficiaries "had no difficulty enrolling," and most feel that "finding the right plan is worth the effort of shopping around," the editorial says.
It adds that the drug benefit "seeks a balance between reigning in the cost of prescriptions and encouraging pharmaceutical advancement" through "competition between providers." The editorial concludes, "The success of Part D is crucial, as the effectiveness of empowering consumers to choose between competing plans will shape future reforms to the Medicare system" (Washington Times, 4/4).