States Address Concerns About Medicare Drug Benefit
Governments in at least four states last week took legislative action to address concerns that poor individuals have been unable to obtain needed medications since the Medicare drug benefit began on Jan. 1, the New York Times reports. Complaints from some state officials, patient advocates and pharmacists suggest a "widespread pattern of problems" related to the new benefit, according to the Times.
For example, low-income beneficiaries in Alabama have been charged the full $250 deductible and copayments higher than $5 per prescription, despite Medicare rules stating that the lowest-income beneficiaries would not be responsible for such costs, according to Carol Herrmann-Steckel, commissioner of the Alabama Medicaid Agency.
State officials in Oregon, Texas and other states reported similar problems with copays and deductibles, the Times reports. In addition, some people were unable to obtain their medications because they did not have proof of coverage, and pharmacists could not verify their eligibility because of overwhelmed phone lines at insurers, according to the Times.
In many cases, insurers did not have access to eligibility information, according to Michael Polzin, a spokesperson for Walgreen.
Cynthia Tudor, a senior Medicare official, on Wednesday said that insurers must "immediately make improvements" to "ensure that all beneficiaries get their prescriptions filled at the point of sale."
On Saturday, CMS Administrator Mark McClellan said he is working closely with states to address problems and to help individual beneficiaries.
To address access concerns, Gov. James Douglas (R) said Vermont will pay drug claims for low-income beneficiaries until CMS finds a solution to the problems.
Maine Gov. John Baldacci (D) made a similar announcement last week, and since Jan. 3, the state has incurred $2 million in expenses related to the drug benefit, the Times reports.
North Dakota Gov. John Hoeven (R) announced plans for a similar program on Friday, and New Hampshire Gov. John Lynch (D) signed an executive order authorizing the state to pay drug claims for beneficiaries whose medications are not covered by their Medicare plan (Pear, New York Times, 1/8). He said the new benefit "has been a nightmare for many of our citizens."
Baltimore also has agreed to pay prescription drug costs for dual eligibles who have problems obtaining needed medications (Pugh, Miami Herald, 1/8).
The Wall Street Journal on Saturday published a question-and-answer piece in which it responds to readers' questions about the so-called "doughnut hole" in the new drug coverage and the deadlines for enrolling in Medicare prescription drug plans (Rubenstein, Wall Street Journal, 1/7).
Many critics are saying that the new Medicare drug benefit "looks like a political blunder of far-reaching consequences," and they are blaming President Bush adviser Karl Rove, columnist Robert Novak writes in a Chicago Sun-Times opinion piece. According to Novak, the drug plan "was an audacious effort to co-opt the votes of seniors."
However, he says, Rove's effort to "entice low-to-middle income seniors who vote heavily Democratic and complain about the cost of prescription drugs ... was translated by bureaucrats and health care technicians into a government program so difficult to understand that someone now receiving any prescription drug care would be inclined to stick with their present program, even if it seems inadequate." Novak adds that "[f]or many whose insurance does not help pay drug bills, the Bush program is only a disappointment."
As the new drug benefit begins, it is shaping up to be a "major new entitlement that offends Bush's friends and does not placate his foes," Novak writes, concluding, "[t]here is not much at this point that can be done about it, except to try to convince seniors and conservatives that the program is really not that bad" (Novak, Chicago Sun-Times, 1/9).
APM's "Marketplace Money" on Friday reported on some beneficiaries' difficulties accessing their prescription drugs through the new Medicare benefit. The segment includes comments from Robert Hayes, president of the Medicare Rights Center, pharmacists and Medicare beneficiaries (Scott, "Marketplace Money," APM, 1/6).
Additional information about the Medicare drug benefit is available online.
The complete segment is available online in RealPlayer.
In addition, CBS' "Evening News" reported on some dual eligibles who learned that although they were automatically enrolled in Medicare prescription drug coverage, their coverage does not cover their prescribed medications. The segment includes comments from pharmacist Michael Kim and Medicare beneficiaries (Andrews, "Evening News," CBS, 1/6).
A transcript of the segment is available online. The complete segment is available online in RealPlayer.