Senate Democrats Ask Bush To Extend Medicare Prescription Drug Benefit Transition Period

Ten Senate Democrats sent a letter to President Bush asking him to extend a transitional period under which private health plans administering the Medicare prescription drug benefit are required to cover all necessary and existing prescriptions for beneficiaries, CQ HealthBeat reports (Carey, CQ HealthBeat, 3/31). The transitional period expired March 31.

Health plans originally agreed to offer 30 days of emergency coverage for drugs that beneficiaries had been taking but that would not be covered under their new plan. In February, Medicare officials requested that the health plans extend the coverage period to 90 days, through the end of March. The additional time was intended to help beneficiaries find generic equivalents to their medications, request exceptions from coverage rules from their insurer or switch plans (California Healthline, 3/31).

According to the Democrats' letter, "There has still been little or no education as to what happens when the transition policy ends, including how to file appeals." Some advocates also have expressed concerns that beneficiaries might not be aware that the transition period is ending.

CMS Administrator Mark McClellan said that "[w]ell under half" of beneficiaries who are obtaining drugs through transitional coverage continue to take medications that are not covered by their drug plans. CMS has told drug plans that they need to take steps to inform beneficiaries about the change, McClellan said.

Plans should ensure beneficiaries are informed of prior authorization requirements ahead of time so they do not experience a disruption of coverage, and they should ensure beneficiaries do not face delays because appeals have not been resolved, CMS said. Plans that cannot resolve appeal or exception requests without delays should provide beneficiaries with a temporary medication supply, CMS said. McClellan said a standardized form for appeals and exceptions will be posted on the CMS Web site within days.

Karen Ignagni, president and CEO of America's Health Insurance Plans, said the insurance industry is "reaching out to beneficiaries, their physicians and pharmacists to provide information about plan processes for exceptions and appeals and alternatives to nonformulary drugs" (CQ HealthBeat, 3/31).

In related news, House Ways and Means Health Subcommittee Chair Nancy Johnson (R-Conn.) on March 27 sent a letter to McClellan questioning him about the implementation of the drug benefit, the end of the transition period, the upcoming enrollment deadline and other issues. Johnson asked "some two dozen specific questions," including requests for the average wait times for beneficiaries and pharmacists who call the Medicare help line.

Johnson also asked about low-income beneficiaries who have switched plans but continue to be enrolled in their original plans. "How is CMS addressing this situation?" Johnson wrote.

She also asked about changes to next year's Medicare handbook, CMS oversight of the appeals process and if the agency is "prepared for a surge of sign-up before the May 15th deadline." In addition, she praised the agency's efforts, saying "[P]remiums are very affordable and many seniors are realizing many thousands of dollars in savings."

She requested a response to the questions by April 21 and said she plans to hold a hearing "to focus on the steps CMS is taking to encourage beneficiaries to sign up." According to CQ HealthBeat, the letter marks "a move into oversight Democrats say should have happened months ago" (Reichard, CQ HealthBeat, 3/31).

NPR's "Weekend Edition Sunday" reported on the end of the transitional period. The segment includes comments from Robert Hayes, president of the Medicare Rights Center; McClellan; Tim Tucker, a pharmacist in Huntington, Tenn.; and a Medicare beneficiary who received notice that one of her medications is not covered by her new plan (Silberner, "Weekend Edition Sunday," NPR, 4/2). The complete segment is available online in RealPlayer.