Republican Senators Discuss Drug Benefit With McClellan, Leavitt
About 30 Senate Republicans on Tuesday met privately with HHS Secretary Mike Leavitt and CMS Administrator Mark McClellan to discuss concerns about the Medicare prescription drug benefit, The Hill reports. According to an unidentified senator who attended the session, lawmakers questioned Leavitt and McClellan about concerns that the drug benefit offers too many plans and could confuse beneficiaries.
In addition, the senator said, lawmakers discussed the so-called "doughnut hole," or the gap in drug benefit coverage, under which Medicare beneficiaries are responsible for annual drug costs between $2,250 and $5,100.
Leavitt and McClellan told senators that 24 million of 42 million eligible beneficiaries have enrolled in the drug benefit; 250,000 beneficiaries sign up weekly; and average monthly individual premiums have decreased from $37 to $25. To address concerns about the doughnut hole, the government is sending letters to beneficiaries to alert them when their medication costs are approaching the coverage gap, Leavitt and McClellan said.
The alert could allow beneficiaries time to switch plans to avoid the doughnut hole, they said.
Sen. Pete Domenici (R-N.M.) said legislative changes to the drug benefit are unnecessary, adding that "every management tool should be used to smooth this over as best as possible." He said, "When it works it's going to help a lot of people," but that "it's too bad management-wise we haven't got better assistance and put out [a] better word."
Sen. Larry Craig (R-Idaho) said he disagreed with colleagues who said the drug benefit offered too many plans or could confuse beneficiaries. He said, "My retort was: 'You want one federal program, take it or leave it?'"
Sen. John Ensign (R-Nev.), who voted against the drug benefit, said Congress should "restructure the program and make it means-tested."
Tuesday's meeting comes as Republican lawmakers "prepare for an expected Democratic assault" on the drug benefit, The Hill reports. Last week, Democratic strategists Stan Greenberg, James Carville and Matt Hogan released a memorandum urging Democrats to criticize the Republican's handling of the drug benefit.
The memo says, "Democrats now have the opportunity to raise opposition to the drug benefits to new heights and use the plan as a powerful symbol of Republican corruption and irresponsibility." It continues, "Coupled with attacks over budget cuts to Medicare, an assault on the prescription drug program could cause serious damage to the GOP, especially among seniors." According to the memo, opposition to the drug benefit among voters ages 50 to 64 has increased from 38% in the fall to 51%, and voters ages 65 and older are opposed to the drug benefit by a 28-point margin.
Sen. Jay Rockefeller (D-W.Va.), ranking member of the Senate Finance Committee Health Subcommittee, said he had drafted legislation that would eliminate coverage gaps for low-income and disabled beneficiaries. Rockefeller said other Democrats have drafted legislation to alter the drug benefit, but they are waiting to reveal their proposals as a comprehensive party plan for Medicare.
Rockefeller said, "The question is whether we come out with plans right now or let [Republicans] vent" (Bolton, The Hill, 2/15).
Monthly premiums and formularies vary greatly among Medicare drug plans, according to an analysis of the Medicare prescription drug benefit by Avalere Health, CQ HealthBeat reports. The report analyzes data on 3,000 Medicare drug plans. According to the report, Medicare drug plans are more likely than other health plans to implement prescription drug cost controls such as step therapy, prior authorization and quantity limits.
In addition, cost sharing tends to be higher in Medicare drug plans than other health plans, the report says. According to the report, average monthly premiums for Medicare Advantage plans are nearly $18 lower than for prescription drug plans. Overall, 496 drug plans offer plans with no premium, the report finds.
In addition, the report finds:
- On average, formularies for PDPs include 1,526 medications, compared with 1,456 medications for MA plans;
- Formularies for Medicare drug plans tend to include fewer medications than formularies for commercial drug plans;
- 66% of PDPs and 75% of managed care plans offer zero- or reduced-deductible plans;
- 51% of stand-alone PDPs and 63% of MA plans have at least four coverage tiers, compared with an average of three tiers for commercial plans; and
- Few plans offer coverage during the doughnut hole (Carey, CQ HealthBeat, 2/14).
According to a separate poll by Harris Interactive, most beneficiaries enrolled in a Medicare drug plan have found it difficult to choose a plan and understand the plan's benefits, but most enrolled beneficiaries do not consider their plan difficult to use, Wall Street Journal Online reports.
The poll, which was conducted online from Feb. 7 to Feb. 9, surveyed 2,477 U.S. adults of all ages. Of respondents ages 65 and older who are enrolled in Medicare drug plans, 60% agreed with the statement, "It is/has been difficult for me to choose a plan," and 63% agreed with the statement, "It is/had been difficult for me to understand the benefits." However, only 26% agreed with the statement, "It is/has been difficult for me to use the plan."
In addition, 60% of enrolled beneficiaries said they have not had trouble reaching a person "who could answer questions about their benefit plan" (Wall Street Journal Online, 2/15).