States Take Actions To Help Dual Eligibles Receive Medicare Drug Benefits

A number of states have taken actions to help dual eligibles who have experienced problems with access to medications under the new Medicare prescription drug benefit. Summaries appear below.

Gov. Tim Pawlenty (R) on Saturday said that the state will pay for prescriptions drugs for dual eligibles who cannot obtain medications, the St. Paul Pioneer Press reports. Pawlenty said that he does not expect reimbursement from the federal government for costs incurred by the state. Pawlenty said that he supports the use of funds from the state Health Care Access Fund to cover the cost.

About 700 of the estimated 100,000 dual eligibles in the state have unresolved problems with access to medications, the Pioneer Press reports. The order issued by Pawlenty remains in effect for five days, and he could extend the order an additional 30 days.

After 35 days, an additional extension of order requires action by the state Legislature (Stassen-Berger, St. Paul Pioneer Press, 1/15).

Gov. Kenny Guinn (R) and officials in his administration have asked for more information from CMS before they decide whether to pay for prescription drugs for 17,000 dual eligibles, which would cost about $6 million monthly, the AP/Nevada Appeal reports.

Mike Hillerby, chief of staff for Guinn, said that the state has provided medications to some Medicare beneficiaries on a case-by-case basis. Hillerby said, "We have to make sure people get their medications, but that's a lot of money and we can't do it for an extended period of time."

Mike Wilden, chief of state health and human services, said, "We're at a critical-mass stage, hoping this smoothes out. I'm not making a recommendation yet on flipping the switch, but we have a contingency plan to do that" (Riley, AP/Nevada Appeal, 1/10).

Gov. George Pataki (R) on Friday enacted an emergency measure that directed the state Department of Health to suspend Medicaid rules for the next seven days and pay for prescription drugs for dual eligibles, the AP/New York Times reports. The state will seek federal reimbursement for costs incurred as a result of the measure.

Pataki said, "Over the coming days, we will carefully monitor the situation and continually reassess our options to ensure that the new federal program is properly implemented and New Yorkers are able to get the medication they need."

The state will seek federal reimbursement for costs incurred as a result of the measure (AP/New York Times, 1/14).

Sen. Chuck Schumer (D-N.Y.) on Tuesday said that the state should not have to cover the cost (Carleo-Evangelist, Albany Times Union, 1/18).

Gov. Ed Rendell (D) on Tuesday announced a measure under which pharmacists can directly bill the state for the cost of prescription drugs for dual eligibles, the Philadelphia Inquirer reports. The announcement expands a measure announced by Rendell last Thursday under which pharmacists can bill the state for high copayments mistakenly charged to dual eligibles because of a computer glitch.

Under the measures, beneficiaries must provide their most recent Medicaid and Medicare cards to prove eligibility. According to the Inquirer, the state has sent information about the measures to pharmacists by e-mail or fax, and the information is available on the state pharmacy Web site. However, some pharmacists said that they were unaware of how to bill the state or that they could not find the information online (Sullivan, Philadelphia Inquirer, 1/17).

State Rep. Garnet Coleman (D) in a letter sent on Tuesday to Gov. Rick Perry (R) and state Health and Human Services Commissioner Albert Hawkins called for a temporary emergency measure to help low-income Medicare beneficiaries who are overcharged under the prescription drug benefit, the Houston Chronicle reports. "We shouldn't leave our people vulnerable, and it's very important that seniors and the disabled have complete access to their prescription drugs," Coleman said.

Rachael Novier, a Perry spokesperson, said that the governor has not decided whether such action is necessary. "We are investigating all of our options and ways to best help Texans mitigate changes in this plan," she said (Houston Chronicle, 1/18).

Gov. Jim Doyle (D) recently announced a measure under which the state will pay for prescription drugs for dual eligibles who cannot obtain medications, the AP/St. Paul Pioneer Press reports. Pharmacists who cannot process claims through Medicare can bill the state Medicaid program, according to Doyle.

The state will seek federal reimbursement for costs incurred as a result of the measure.

Helene Nelson, secretary of the state Department of Health and Family Services, said as many as one-fifth of dual eligibles in the state might not have access to medications because of problems with the Medicare prescription drug benefit, adding, "It is hard to know how many people would be affected" (AP/St. Paul Pioneer Press, 1/14).