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Medicare Drug Program News
Wisconsin's Low-Income Drug Program Being Closed by
Medicare
Hasn't proven SeniorCare reduces costs for
federal government
April 11, 2007- SeniorCare, a program by the State
of Wisconsin, that offered lower income senior citizens a much less
costly drug program than Medicare Part D, is being shut down by the
Centers for Medicare & Medicaid Services, according to a report by
KaiserNetwork.org. CMS says it does not meet the requirement for saving
federal money, but state officials disagree and say it is more efficient that
Part D.
CMS Pulls Federal Funding From
Wisconsin's SeniorCare Prescription Drug Program
CMS
last week rejected a request for a new Medicaid waiver for
SeniorCare,
a Wisconsin prescription drug program for low-income seniors, the
Washington Post reports (Lee,
Washington Post, 4/10).
In 2005, before the implementation of the Medicare
prescription drug benefit,
HHS
issued a waiver to allow Wisconsin to continue to operate SeniorCare
until at least June 30.
SeniorCare has no monthly premiums, lower
copayments than the Medicare prescription drug benefit and no gaps in
coverage. In addition, SeniorCare, unlike the Medicare prescription drug
benefit, does not measure the assets of beneficiaries.
Wisconsin Gov. Jim Doyle (D) requested a new waiver
to allow the state to continue to operate SeniorCare for three
additional years (Kaiser
Daily Health Policy Report, 3/29).
SeniorCare, which began in 2002, has enrolled more
than 100,000 Wisconsin residents ages 65 and older with annual incomes
less than 240% of the federal poverty level. Under SeniorCare,
beneficiaries pay a $30 annual fee and copayments of $5 for generic
medications and $15 for brand-name treatments after they reach an annual
deductible based on income.
SeniorCare beneficiaries with annual incomes more
than $16,336 pay deductibles of $500 or $850, and those with annual
incomes less than $16,336 pay no deductible. SeniorCare obtains
medications at a discount through Medicaid, and Wisconsin officials
negotiate additional rebates with pharmaceutical companies.
CMS Comments
According to acting CMS Administrator Leslie
Norwalk, the agency rejected the request for a new waiver because the
state has not provided evidence that SeniorCare reduces costs for the
federal government as required.
Norwalk also said that, because SeniorCare does not
measure the assets of beneficiaries, "I don't know whether or not these
people would ever qualify for Medicaid."
She said, "All they have done, basically, is shift
costs to the Medicaid program that should not be borne there."
In addition, Norwalk said that private plans under
the Medicare prescription drug benefit can negotiate more comprehensive
and affordable options for beneficiaries than SeniorCare (Lee,
Washington Post, 4/10).
CMS will allow Wisconsin to continue to operate
SeniorCare until the end of the year to help with the transition to the
Medicare prescription drug benefit.
Reaction
According to Doyle, Norwalk and other CMS officials
did not consider evidence that SeniorCare reduces costs for the federal
government, the
Dow Jones/Milwaukee Journal Sentinel reports
(Walters/Forster, Dow
Jones/Milwaukee Journal Sentinel, 4/5).
Wisconsin officials said that SeniorCare has saved
the federal government a total of $669 million in Medicaid costs and
estimated that the program would save an additional $400 million over
the next three years.
Jason Helgerson, director of the Wisconsin Medicaid
program, said that the federal government pays $617 annually for the
average SeniorCare beneficiary, compared with almost $1,200 annually for
the average Medicare beneficiary enrolled in the prescription drug
benefit.
Helgerson said, "We think the empirical evidence is
extremely clear that SeniorCare is more cost-effective than Part D and
for the simple reason that we negotiate with the drug companies and the
federal government doesn't."
Doyle said, "The Bush administration is making a
terrible mistake. As a result, Wisconsin seniors will pay more and get
less coverage, while drug companies make even larger profits. Our state
won't be allowed to negotiate better prices on behalf of our seniors as
we do now" (Washington Post,
4/10).
Doyle, state lawmakers and advocates for Wisconsin
seniors said that they will seek to establish supplemental coverage for
the Medicare prescription drug benefit in place of SeniorCare (Dow
Jones/Milwaukee Journal Sentinel, 4/5).
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