Potential Medicare Part D Enrollment ‘Surge’ Could Cause Delays
A "surge of new enrollment" in Medicare drug plans ahead of the May 15 deadline could affect "already busy phone lines and leave beneficiaries struggling to figure out how to sign up for the new plan," the New York Times reports. HHS Secretary Mike Leavitt has advised beneficiaries to "act soon to avoid any last-minute rush" as the deadline approaches.
Federal regulations require Medicare drug plans to answer 80% of calls to telephone help lines within 30 seconds. However, wait times to speak with a customer service representative at Humana, one of the largest sponsors of Medicare drug plans, often reached 30 minutes last week, the Times reports.
Humana spokesperson Thomas Noland said, "The large amount of interest in our prescription drug plans, as the May 15 deadline approaches, means that the wait times are longer than we would like."
A federal contractor is making calls to insurers to monitor call center performance, and "[t]est calls to several large insurers suggest that they frequently miss" the federal standards, according to the Times. The performance data has been provided to each insurer, and CMS officials have said the information should be publicly available before May 15.
CMS Administrator Mark McClellan said officials will consider the performance data in deciding whether to renew insurers' Medicare contracts for next year. CMS also might impose fines or take other enforcement action against insurers that are "substantially out of compliance" with federal standards, McClellan said (Pear, New York Times, 4/24).
Senate Finance Committee Chair Chuck Grassley (R-Iowa) and Sens. Max Baucus (D-Mont.), Orrin Hatch (R-Utah) and Jay Rockefeller (D-W.Va.) on Friday sent a letter to Pharmaceutical Research and Manufacturers of America President Billy Tauzin urging drug makers to continue their patient assistance programs for Medicare beneficiaries, CQ HealthBeat reports. The senators write that an advisory opinion issued Tuesday by HHS Inspector General Daniel Levinson makes it clear there are lawful ways for PAPs to operate under the Medicare drug benefit without violating federal anti-kickback laws.
"It is simply unacceptable for any pharmaceutical company to use the launch of the new Medicare prescription drug benefit as an excuse to limit their [PAPs] as of May 15, particularly since there is now clear legal guidance from the OIG on ways to operate these programs," the letter says. The letter adds that, although the advisory opinion is specifically directed at PAPs operated by Schering Plough, other drug makers can use it as "a workable road map."
PhRMA Senior Vice President Ken Johnson said decisions on whether to continue PAPs "will be made individually by each company." He added, "It's important to remember that [PAPs] are designed to be safety nets for people who have no place else to turn. That's what they have been historically, ... and seniors clearly have an option now, and it's called Part D." He added that "[a] number of [companies] are going to continue to provide assistance," but "[w]e don't have any way of knowing at this point what the entire industry is going to do" (Carey, CQ HealthBeat, 4/21).
Two newspapers on Sunday examined issues related to the upcoming enrollment deadline. Summaries of the article appear below.
San Francisco Chronicle: The Chronicle on Sunday examined beneficiaries' concerns as the enrollment deadline approaches. During a visit to San Francisco last week, Leavitt urged beneficiaries to sign up before May 15 to avoid financial penalties (Colliver, San Francisco Chronicle, 4/23).
- Wall Street Journal Online: The Journal on Sunday examined the benefits of signing up for Medicare drug coverage and looked at why "about six million eligible beneficiaries haven't signed up." According to the Journal, "Many beneficiaries apparently are confused about what to do or have decided not to enroll in a drug plan because they don't think it will save them money" (Lueck, Wall Street Journal, 4/23).