Schwarzenegger Says State Will Pay for Emergency Supply of Medications for Some Medicare Drug Beneficiaries
Gov. Arnold Schwarzenegger (R) on Thursday ordered the state to provide five-days of temporary emergency prescription drug coverage for one million residents dually eligible for Medicare and Medi-Cal who are having problems obtaining medications under the Medicare drug benefit, the San Jose Mercury News reports (Feder Ostrov, San Jose Mercury News, 1/13). The Legislature on Tuesday is expected to approve a bill that would extend emergency coverage for an additional 10 days (Benfell, Santa Rosa Press Democrat, 1/13).
An estimated one in five Medi-Cal beneficiaries might still be having problems with coverage (Weaver Teichert, Sacramento Bee, 1/13).
The 15-day emergency coverage likely would cost about $70 million, according to Medi-Cal Director Stan Rosenstein (Pear, New York Times, 1/13).
Health and Human Services Agency Secretary Kim Belshe said the state "intends to aggressively pursue full reimbursement" for the coverage from the federal government (Clark, San Diego Union-Tribune, 1/13).
According to state health officials, dual eligibles will be reimbursed for out-of-pocket costs that exceeded their $1 to $5 copayments. Patients who were unable to obtain medications should see if they are now eligible for coverage in the Medicare system, and if their requests are still denied, the state will cover the cost as a "payer of last resort," officials said (Alonso-Zaldivar/Nicholas, Los Angeles Times, 1/13).
Pharmacies will be reimbursed the costs of medicines as long as they can document problems with the Medicare drug benefit or the drug plans (San Diego Union-Tribune, 1/13).
State officials will examine the benefit at the end of the month to decide whether emergency help should be extended (Los Angeles Times, 1/13). At least 13 other states have implemented such stop-gap measures for dual eligibles (Colliver, San Francisco Chronicle, 1/13).
The Department of Health Services on Friday said the state processed 12,990 prescription claims between 5 p.m. Thursday and 4:30 p.m. Friday that could not previously be processed (Colliver, San Francisco Chronicle, 1/14).
State officials "cautiously predicted" that the emergency measure "might provide enough breathing room to get the Medicare Part D plan fully implemented" before enrollment ends on May 15, the Sacramento Bee reports (Weaver Teichert, Sacramento Bee, 1/14).
Schwarzenegger, Senate President Pro Tempore Don Perata (D-Oakland) and other legislative leaders in a letter on Friday asked HHS Secretary Mike Leavitt to create a temporary automated billing system that would directly bill Medicare for the cost of dual eligibles' drugs (Vesely, Oakland Tribune, 1/14).
Schwarzenegger also called on HHS "to reimburse California taxpayers for the cost of providing temporary emergency coverage to its most vulnerable residents" (Reitman/Hernandez, Los Angeles Times, 1/14).
In addition, Sen. Dianne Feinstein (D) sent a letter to Bush administration officials demanding that problems with Medicare be fixed and that the federal government reimburse states for covering dual eligibles' medications (Feder Ostrov, San Jose Mercury News, 1/14). Feinstein wrote that the drug benefit has resulted "in a major health emergency" in the state (Los Angeles Times, 1/14).
Rosenstein also called on CMS to implement an automated system that would enable the agency to pay for dual eligibles' prescriptions (Goldeen, Stockton Record, 1/13).
Medicare spokesperson Jack Cheevers said pharmacists can bill a special account to provide drugs to patients with urgent needs. He added that insurance companies are expected to reimburse patients who have been overcharged (Perkes/Sarhaddi Nelson, Orange County Register, 1/13).
The following articles also address the Medicare drug benefit:
- "Prescription Drug Debacle" (Greenberg, Los Angeles Daily News, 1/16).
- "Shaky Start to Drug Plan May Point to Rougher Seas Ahead" (Zagaroli, Sacramento Bee, 1/14).
Summaries of editorials addressing the Medicare drug benefit appear below.
Los Angeles Daily News: It is "commendable" that Schwarzenegger and other governors are helping "those caught in the Medicare madness," but "[i]t's up to Congress to step in and fix this mess immediately," a Daily News editorial states (Los Angeles Daily News, 1/17).
Sacramento Bee: The "mangled drug benefit is truly a disaster" and "demands an appropriate response" from Congress and the Bush administration, according to a Bee editorial (Sacramento Bee, 1/15).
Santa Rosa Press Democrat: Schwarzenegger hopes to be reimbursed by the federal government for covering dual eligibles' medications, and to this a Press Democrat editorial "offer[s] two words: Good luck" (Santa Rosa Press Democrat, 1/16).
The text of the letter from Schwarzenegger and California Legislative leaders to HHS is available online.
Additional information on the Medicare drug benefit is available online.
KPCC's "AirTalk" on Friday discussed Schwarzenegger's emergency plan. The segment includes comments from:
- John Cronin, senior vice president of the California Pharmacists Association;
- Steve Deering, deputy regional director for CMS;
- Ann Kasper, program director of Inland Agency's Health Insurance Counseling and Advocacy Program; and
- Stan Rosenstein, state deputy director of medical services (Mantle, "AirTalk," KPCC, 1/13). The complete segment is available online in RealPlayer.