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Medicare Drug Plan Deadline Extension Not Legal,
Says CMS
April 18, 2006 With the May 15 deadline for
enrolling in the Medicare Drug Program less than a month away, the
voices begging for an extensions are growing louder, but the deputy
administrator at the Centers for Medicare and Medicaid services says
there is no legal way to extend the deadline. The media, too, seems to
have increased its interest in the program, including the announcement
that rates are going up about seven percent in 2007, according to a
round-up of Medicare news by KaiserNet.org.
 Medicare Drug Benefit Deadline Extension 'Not
Legally Permissible,' CMS Deputy Administrator Norwalk Says
An extension of the May 15 enrollment deadline for
the Medicare prescription drug benefit is "legally not permissible,"
CMS
Deputy Administrator Leslie Norwalk said on Friday, the
AP/St. Paul Pioneer
Press reports.
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Choose Carefully as Medicare Drug Benefit Deadline
Nears on May 15
Kaiser Family Foundation
finds wide variations
across plans
April 14, 2006 - Medicares new private stand-alone drug plans vary
significantly in terms of covered drugs, out-of-pocket costs for
specific medications, and restrictions placed on the use of certain
drugs - according to a new analysis released today by the Kaiser Family
Foundation.
Read more...
Final Medicare Enrollment Effort Begins Monday
Across the U.S.
Hundreds of events
planned for 'Medicare Rx Get Enrolled Week'
April 12, 2006 With the deadline for enrollment
for the Medicare drug program looming May 15 and new polls showing
satisfaction with the program, a week-long grassroots effort is being
held April 17-23 in all 50 states and Washington D.C. to help senior
citizens get enrolled. Medicare Today, a national partnership of more
than 400 organizations, today announced "Medicare Rx Get Enrolled Week."
Medicare experts and volunteers will provide seniors with the
information they need to make decisions about enrollment in Medicare's
prescription drug benefit.
Read more...
Read more
on
Medicare Drug Program |
|
The 2003 Medicare law states that a "special
enrollment period" beyond the deadline can be established only for
beneficiaries with exceptional circumstances (Freking, AP/St. Paul
Pioneer Press, 4/14). CMS earlier this month announced that it will
allow "ongoing" enrollment in the Medicare prescription drug benefit for
beneficiaries who qualify for a low-income subsidy (Kaiser
Daily Health Policy Report, 4/14).
Democratic lawmakers and some advocacy groups have
been pressing the Bush administration to extend the deadline for all
Medicare beneficiaries. Rep. Rahm Emanuel (D-Ill.) said, "If a delay in
the enrollment deadline is good enough for low-income seniors, it is
good enough for all seniors -- regardless of income."
The
Medicare Rights
Center urged
HHS
Secretary Mike Leavitt to extend the deadline for all beneficiaries
because many are "paralyzed by the array of confusing private drug plan
choices." However, Norwalk said giving an extension to all 43 million
eligible beneficiaries would "undermin[e] what Congress put into place."
She added, "Our actuaries tell us 1.6 million fewer
people would enroll if we do that. We are not going to push back the
deadline." Norwalk also said the deadline encourages people with
relatively few drug expenses to enroll, allowing for lower overall
costs.
Meanwhile, CMS spokesperson Peter Ashkenaz said
beneficiaries who are not sure if they qualify for the low-income
extension should enroll before the deadline (AP/St. Paul Pioneer Press,
4/14).
Basic Plan Costs To Increase
In related news, CMS last week announced that deductibles, coverage
limits and out-of-pocket expenses for basic Medicare prescription drug
coverage will increase by nearly 7% in 2007, the
Wichita Eagle
reports.
Standard plan deductibles will increase from $250
to $265, coverage limitations will increase from $2,250 to $2,400 and
maximum out-of-pocket costs will increase from $3,600 to $3,850. CMS
officials said the increases are required under the 2003 Medicare law
and will not have a great impact on most beneficiaries.
"More than 90% of beneficiaries are not in a plan
with a standard benefit," Ashkenaz said, adding, "In most cases, they
are in plans that have zero or no deductibles and with low copays for
covered drugs" (Atwater, Wichita Eagle, 4/15).
Patient Assistance Programs
Senate Finance
Committee Chair Chuck Grassley (R-Iowa) and Sens. Max Baucus
(D-Mont.), Orrin Hatch (R-Utah) and John Rockefeller (D-W.Va.) on Monday
sent a letter to HHS Inspector General Daniel Levinson asking him to
clarify how the Medicare prescription drug benefit will affect
pharmaceutical companies' patient assistance programs,
CQ HealthBeat
reports.
Some pharmaceutical companies have said they will
end their patient assistance programs on May 15 because they are
concerned that the programs could violate federal anti-kickback laws
that prohibit drug makers from steering beneficiaries toward their own
products. In January, the
Pharmaceutical
Research and Manufacturers of America cited a guidance
document from the inspector general as the reason for ending the
programs.
In the document, Levinson said that drug makers can
lawfully provide assistance to low-income beneficiaries, in part by
contributing to charities that administer the programs. In Monday's
letter, the senators ask Levinson to issue a "prompt and definitive
guidance" to assure pharmaceutical companies that the patient assistance
programs can continue.
The letters says that without such programs, "some
Medicare beneficiaries may not otherwise be able to afford their
prescription drugs, even if they are enrolled in the ... drug benefit."
The letters asks that the clarification be issued "as expeditiously as
possible" (CQ HealthBeat, 4/17).
Additional News Coverage
●
Los Angeles Times:
The Times examines how some beneficiaries have found that Medicare drug
plans' prices "are sometimes little better, and sometimes worse, than
those offered at low-margin pharmacies," especially "[w]hen premiums,
copayments, coverage gaps and other costs are figured in." Several small
surveys have found that warehouse retailers, such as
Costco,
and online pharmacies, such as
Drugstore.com,
offer "better discounts overall" than Medicare drug plans, according to
the Times. However, "[e]xperts say the program clearly can benefit
chronically or catastrophically ill people who take many costly
medications," the Times reports (Reitman, Los Angeles Times, 4/18).
●
USA Today:
USA Today examines how low-income beneficiaries and "those with few
health problems" have been "the slowest to sign up" for the drug
benefit. According to USA Today, beneficiaries who could qualify for a
low-income subsidy "have been the hardest to enroll, often because of
educational or language barriers." Healthy beneficiaries also have not
enrolled in large numbers, mostly because many of them do not have high
drug costs (Wolf, USA Today, 4/18).
Editorials, Opinions
Several editorials and opinion pieces and a letter to the editor
recently addressed the Medicare prescription drug benefit. Summaries
appear below.
●
USA Today:
A "long extension" of the deadline for enrolling in the drug benefit
"would be a mistake" because "many" beneficiaries would then "be tempted
to delay [enrollment] until they need expensive medicines," a USA Today
editorial states. However, the editorial adds, "a short extension might
be needed to cope with problems caused by a last-minute rush" (USA
Today, 4/17).
● Brad Woodhouse,
USA Today:
The benefit "is so hopelessly flawed that the enrollment deadline ...
must be extended to give Congress time to fix this debacle," Woodhouse,
communications director for Americans United, writes in a USA Today
opinion piece. Woodhouse concludes that Congress should use a deadline
extension to make the benefit "simple, affordable and guaranteed"
(Woodhouse, USA Today, 4/17).
●
Washington Post:
"At the time this drug benefit was rolled out, the leadership of [HHS]
was eager to point out that the much-criticized private-sector
involvement with the benefit was designed not to rip off seniors but to
provide them with cheaper drugs over time," a Post editorial states. The
editorial adds, "It is too early to say whether this process has begun
to work," and "only when there have been several rounds of annual plan
selections ... will it be possible to declare whether this artificially
designed market has been a 'success' or a 'failure'" (Washington Post,
4/15).
● Rep. Pete Stark (D-Calif.),
Washington Post:
"The nonpartisan
Congressional
Budget Office ... determined that a one-time extension of the
enrollment deadline would result in an additional 1.1 million sign-ups
this year -- and lower premiums and late-enrollment penalties for 10
million more Medicare beneficiaries for the rest of their lives," Stark
writes in a letter to the editor of the Post. Stark notes that a Post
opinion poll found that 71% of seniors support an extension of the
deadline and concludes that, "[r]ather than listening to the drug and
insurance companies that oppose an extension, the president ought to
hear seniors" (Stark, Washington Post, 4/17).
● Donald Lambro,
Washington Times:
Recent polls about the benefit "strongly sugges[t] that the early
doom-and-gloom stories about the program's problems were premature,"
Lambro, chief political correspondent for the Times, writes in an
opinion piece. He adds that the program's "market-oriented structure"
needs "to be broadened and improved in the legislative fine-tuning that
will no doubt be done in the years to come" (Lambro, Washington Times,
4/17).
"Reprinted with
permission from 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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