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Democrats, Advocates Beating Drums for Changes to
Medicare Drug Program
Feb. 16, 2006 – Congressional Democrats and
advocacy groups are beginning a push to make changes in the Medicare
prescription drug program. President Bush, however, says legislative
changes to the drug benefit are unnecessary and HHS Secretary Mike
Leavitt says problems can be corrected with administrative action,
according to a report by KaiserNet.org.
 Medicare | Democrats Prepare Legislation
That Would Alter Medicare Drug Benefit
[Feb 16, 2006]
Some House and Senate Democrats on Wednesday
proposed several legislative changes to the Medicare prescription drug
benefit that they said would ensure beneficiaries could obtain
medications with fewer problems,
CQ HealthBeat
reports.
Speaking at a press conference in Washington, D.C.,
Rep. John Dingell (D-Mich.) and Sens. Richard Durbin (D-Ill.) and Debbie
Stabenow (D-Mich.) said Democrats will hold "hundreds" of meetings with
beneficiaries across the U.S. to highlight problems with the drug
benefit and explain how they would amend the program (Reichard, CQ
HealthBeat, 2/15).
Durbin said Democrats are looking for a Senate bill
to which they can attach the proposed changes (Chayes,
Chicago Tribune,
2/16).
● The Democrats propose that Medicare drug plans
be required to provide beneficiaries with a 60-day supply of any drug
that is not covered by the plan.
● Plans also would be required to provide a 60-day
supply of medication when a pharmacist cannot confirm a beneficiary's
enrollment in a Medicare drug plan.
● In addition, the proposed legislation would
create a standardized appeals process, with medications provided during
the appeal (CQ HealthBeat, 2/15).
● The legislation also would prohibit drug plans
from eliminating medications from a formulary once a beneficiary has
enrolled or "from raising the cost of the drugs in midyear," according
to the Tribune (Chicago Tribune, 2/16).
● In addition, beneficiaries could change drug
plans if a plan did not cover needed medications.
● The proposals also would require Medicare to
reimburse family members, charity organizations and states that covered
the costs of medications for beneficiaries unable to obtain drugs
because of administrative problems with the drug benefit, and
pharmacists could bill Medicare directly for prescription costs for
beneficiaries whose enrollment could not be confirmed because of
administrative issues (CQ HealthBeat, 2/15).
Comments
Durbin said, "We think that we can come together, even on a bipartisan
basis, to make this program work for the people across this country." He
said the drug benefit "has become a costly, complicated mess that wastes
tens of billions of dollars in handouts to pharmaceutical companies and
insurance companies." Stabenow said, "This isn't a political issue.
We're talking about whether people get medicine that will save their
life."
Bush Speech
In a speech on Wednesday in Dublin, Ohio, President Bush said
legislative changes to the drug benefit are unnecessary. "When you have
that big a shift, you can imagine there's going to be glitches," Bush
said, adding, "But, by far, the vast majority of people are signing up
to a program that's making a big difference in their lives" (Chicago
Tribune, 2/16).
Energy and Commerce Hearing
In related news, members of the
House Energy and
Commerce Committee on Wednesday questioned
HHS
Secretary Mike Leavitt about the drug benefit, CongressDaily reports
(CongressDaily, 2/16). Leavitt said problems with the drug benefit can
be corrected through administrative action (CQ HealthBeat, 2/15).
However, he added that he would work with Congress
to address issues with the drug benefit, including concerns about the
May 15 enrollment deadline. Leavitt said the deadline would encourage
beneficiaries to enroll in the drug benefit. "If we do (enrollment)
indefinitely, people will not feel the need to investigate this," he
said (CongressDaily, 2/16).
Committee Chair Joe Barton (R-Texas) said, "Some
sense political advantage in condemning the [drug benefit] and can't
bring themselves to admit that free markets actually work." Barton said
there have been problems with the drug benefit but added that "critics
have tried to make patients believe that they are not smart enough to
understand the new Medicare drug benefit, that it provides inadequate
coverage and that signing up isn't worth their time because it cannot
save them any money.
The critics are simply wrong." Barton told Leavitt
that the committee will hold "the first of what will likely be several
hearings" on the drug benefit on March 1 (CQ HealthBeat, 2/15).
House Budget Committee Hearing
In other Medicare news, U.S. Comptroller General David Walker, head of
the
Government
Accountability Office, told members of the
House Budget
Committee that the drug benefit should be re-examined as part
of a larger restructuring of the way the federal government spends money
on health care programs, the
Washington Times
reports.
Walker suggested increasing the focus on disease
prevention, mandating a limited growth rate for government-sponsored
health care programs, developing a base of essential health care
services and requiring payments for extra services, according to the
Times.
After outlining his overall recommendations, Walker
said, "I would add to that ... relooking at Medicare Part D." Walker
said the federal government would have to invest $8.7 trillion in
today's dollars to pay for the drug benefit program over the next 70
years or more. He said the costs could be reduced if Medicare was
authorized to negotiate drug prices with pharmaceutical companies, a
strategy used by the Department of Veterans Affairs.
However, Douglas Holtz-Eakin, an economist at the
Council on Foreign
Relations and former director of the
Congressional
Budget Office, said negotiating with pharmaceutical companies
would not save much money for Medicare because it serves a different
population than the VA. Holtz-Eakin said the drug benefit should remain
unchanged. "It's a couple of months old," he said, adding, "It's going
to take awhile for this to shake out" (Fagan, Washington Times, 2/16).
Advocacy Groups Call for Changes
The
National Mental
Health Association, the
Epilepsy Foundation,
Paralyzed Veterans of America and
United Cerebral
Palsy on Wednesday called for immediate changes in the drug
benefit that would guarantee prompt reimbursement to beneficiaries who
have been overcharged for copayments and pharmacists who have covered
the cost of medications for beneficiaries because of problems with the
drug benefit, the
Los Angeles Times
reports.
In addition, the groups said Medicare should
standardize forms and procedural requirements. Kirsten Beronio of NMHA
said, "In general, (Medicare) has been addressing problems on a
case-by-case basis, instead of treating them as the systematic problems
that they are." Jeff Kelman, chief medical officer at CMS, said the
agency has "made a lot of effort to work with the disability groups and
the mental health groups, because they represent a very vulnerable and
important population to bring into the benefit." He added, "If we can
get a more standardized and simplified process, it will be much easier.
That is the direction we're heading in" (Alonso-Zaldivar, Los Angeles
Times, 2/16).
Broadcast Coverage
APM's "Marketplace"
on Wednesday reported on Medicare. The segment includes comments from
Medicare Rights
Center President Robert Hayes and Jim Hardy, deputy secretary
of the Pennsylvania
Medical Assistance
Program (Scott, "Marketplace," APM, 2/15).
 The
complete segment is available
online
in RealPlayer.
"Reprinted with
permission from kaisernetwork.org (insert hyperlink to http://www.kaisernetwork.org).
You can view the entire
Kaiser Daily Health Policy Report, search the archives, and sign up
for email delivery at
www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser
Daily Health Policy Report is published for
kaisernetwork.org, a free service of The Henry J. Kaiser Family
Foundation. © 2006 Advisory Board Company and Kaiser Family Foundation.
All rights reserved.”
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