Some Obstacles to Drug Coverage Decrease
Some dual eligibles who are switched to the Medicare prescription drug benefit after becoming eligible for the program are experiencing problems accessing medications, but the problems exist "on a smaller scale" than during the early days of the program, USA Today reports (Wolf, USA Today, 6/16). The government automatically transfers drug coverage for dual eligibles -- beneficiaries who are enrolled in both Medicare and Medicaid -- from state Medicaid programs to Medicare drug plans.
Many dual eligibles who were transferred when the drug benefit first began earlier this year were incorrectly charged copayments or experienced other problems obtaining medications under the new program (California Healthline, 5/16).
According to USA Today, the latest problems for dual eligibles "occur when people turn 65 or become eligible for Medicare disability benefits and are involuntarily switched from Medicaid drug coverage to the new Medicare plan." After these beneficiaries lose their Medicaid drug coverage, it typically takes two to six weeks before they are able to obtain medications under the Medicare benefit, according to USA Today.
Between 10,000 and 70,000 beneficiaries "fall into the gap between Medicare and Medicaid" each month, USA Today reports.
George Oestreich, a Missouri Medicaid official, said, "It's an inherent problem in the design" of the drug benefit.
Jude Walsh, an aide to Maine Gov. John Baldacci (D), said, "This is no way to run a drug benefit," adding, "We're always a month behind."
CMS spokesperson Peter Ashkenaz said dual eligibles who pay out of pocket during the transition period can receive reimbursements from their Medicare drug plans once their coverage begins. Ashkenaz added that beneficiaries can enroll in a Medicare drug plan at the pharmacy counter. Several states have stepped in to provide emergency benefits for dual eligibles who are experiencing problems, he said (USA Today, 6/16).
In related news, a report released on Thursday by the Medicare Payment Advisory Commission said Medicare should take steps to increase management of care and tie physician performance to payment levels as part of its efforts to improve quality of care and reduce costs, CQ HealthBeat reports.
"Controlling spending is essential to assure the sustainability of the program," the report says, adding, "The longer action is delayed, the more draconian the remedies will be required. Medicare must increase the quality and the value of the care it purchases."
MedPAC Executive Director Mark Miller said the commission is considering increasing "care coordination" in traditional fee-for-service Medicare and measuring physicians' "resource use" to improve quality and value. Care coordination would help ensure beneficiaries receive care in the least-costly setting possible and allow them to better manage chronic conditions.
Medicare should use separate care-coordination strategies for large- and small-group practices and for sole practitioners, the report says. For example, Medicare could contract with large-group practices that have their own care management resources to track patient care.
Medicare also could contract with separate care management organizations to provide information technology and other resources to track patient care at smaller practices. MedPAC's analysis indicates that care coordination would improve quality of care, but it is unclear whether the system would help reduce costs, the report says.
Miller said MedPAC also is planning to improve value by paying more to providers who meet quality standards and measuring the resources providers use to deliver care. MedPAC is evaluating whether the current medical literature is sufficient to compare cost-effectiveness of various approaches to treatment, Miller said.
The report also looks at beneficiaries' experiences with the prescription drug benefit. According to the report, beneficiaries mostly obtained information from family members and friends, as well as from insurance agents and drug plan sponsors.
Miller said that fewer beneficiaries used the Medicare Web site or toll-free phone line but that those who did found the resources helpful. In addition, few beneficiaries sought advice from pharmacists or physicians, he said. Miller noted that beneficiaries found the enrollment process confusing but that "they also said they did have enough information to make a decision" (Reichard, CQ HealthBeat, 6/15).