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Medicare Drug Program
Changes Made and Proposed to Improve Medicare Drug
Program
Republican enters bill in House to extend
enrollment deadline
April 28, 2006 With millions of senior citizens
facing the deadline to enroll in a Medicare prescription drug plan by
May 15, a series of actions and proposals are aimed at making the
Medicare Part D program more attractive to seniors. Medicare has told
insurers they must keep drug lists (formularies) and copays the same for
a contract year. Yesterday, two Democrats on the Senate Finance
Committee proposed a bill to simplify the program, according to a report
by KaiserNet.org. Meanwhile, a House Republican filed a bill to extend
the enrollment deadline to the end of the year.
 Senate Finance Committee
Democrats Propose Legislation That Would Alter Medicare Drug Benefit
Sens. Max Baucus (D-Mont.), ranking member on the
Senate Finance Committee, and Blanche Lincoln (D-Ark.), also a
member of the committee, proposed two bills on Thursday that they said
would simplify the Medicare prescription drug benefit,
CQ HealthBeat reports.
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Related Stories |
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Medicare Rules Drug Plans Cannot Change Formularies
Mid-Stream
April 27, 2006 Senior citizen consumer advocates
seemed to have won at least one battle to make changes in the Medicare
prescription drug program. Under the program, insurance companies had
the right to change the drugs they offer (formulary list) at any time.
Under the new rule, however, they must stay the same for a full contract
year. But, a new storm arose in a lawsuit charging
HHS
Secretary Mike Leavitt failed to ensure that "dual eligibles," whose
drug coverage was transferred from Medicaid to Medicare on Jan. 1, had
access to medications under the drug benefit. It's all covered in the
daily report from KaiserNet.org.
Read more...
Insurers Support Keeping Medicare Copays,
Medications Consistent
Endorses CMS plan to keep
Medicare Part D plans firm for contract year
April 27, 2006 - The Board of Directors of
Americas Health Insurance Plans (AHIP), a national association
representing nearly 1,300 companies providing health insurance coverage,
today issued a statement in support of the principle of providing
"continuity of care" for beneficiaries in Medicare Part D. It
specifically supports CMS efforts to ensure that beneficiaries who have
been prescribed a medication on a Part D formulary will not be required
to change their medication or pay increased copays or coinsurance
throughout a contract year.
Read
more...
Medicare Drug Plan Provider Offers Advice to Seniors
Facing May 15 Deadline
Analysis of 50,000 enrollees finds confusion,
misunderstanding & frustration was rampant
April 25, 2005 The volume of information from
Medicare and drug plans has been overwhelming to senior citizens trying
to join the Medicare Part D prescription drug plan, but those who have
not joined should not be discouraged, says Connextions Health. They also
offer advice to those not enrolled as the May 15 deadline nears. The
company bases the information on experience in assisting over 50,000
senior citizens to enroll.
Read more...
Read more
on
Medicare Drug Program |
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One bill would create six defined types of drug
plans with the aim of easing the comparison process for beneficiaries.
In addition, the bill would prohibit drug plans from making changes to
their formularies during the plan year and require plans to submit
quality and appeals data, which would be available to beneficiaries.
A second bill would require drug plans to reimburse
pharmacies more quickly and establish hotlines for pharmacists. Some
pharmacists have said slow reimbursements have disrupted their cash flow
and forced them to borrow money to remain in business.
The second bill also would prohibit marketing
practices that could mislead beneficiaries about which pharmacies are in
a plan's network. Baucus said the implementation of the drug benefit
"has been skewed way too much toward insurers," adding, "We want
pharmacists to be treated like partners, not piggybanks."
CMS spokesperson Peter Ashkenaz said the agency is "busy taking
action now" to help beneficiaries enroll and is working to resolve
pharmacists' concerns "as quickly as they are raised" (Carey, CQ
HealthBeat, 4/27).
Deadline
In the House, Rep. Jeb Bradley (R-N.H.) has proposed a bill that would
extend to Dec. 31 the deadline for enrolling in the drug benefit without
incurring a financial penalty, the
AP/Manchester Union Leader reports.
The current deadline to enroll without penalty is
May 15. Bradley said beneficiaries should be given additional time to
enroll because of confusion and problems with the implementation of the
drug benefit. Brian Cresta, regional director of CMS, said the Bush
administration does not support a deadline extension because it has met
its enrollment goal (AP/Manchester Union Leader, 4/28).
Fraud
CMS Administrator Mark McClellan on Thursday said the Bush
administration will not tolerate drug plans that mislead beneficiaries
or act fraudulently, the
San Antonio Express-News reports. McClellan, who was visiting
several cities in Texas as part of a nationwide bus tour to promote the
drug benefit, said CMS has received a few complaints about drug plans
that have provided beneficiaries with misleading information. He added
that the agency generally has been able to address problems through
enforcement letters (Poling, San Antonio Express-News, 4/27).
Additional Coverage
Two publications featured news on the new formulary policy announced
by the Bush administration on Wednesday that requires insurers
sponsoring Medicare drug plans to allow enrolled beneficiaries to
continue receiving coverage for medications, even if the company drops
the drugs from its formulary (Kaiser
Daily Health Policy Report, 4/27). Summaries appear below.
● CongressDaily: Sen. Olympia Snowe (R-Maine),
who had proposed legislation similar to the new formulary policy, said
she is pleased with the change but noted that it does not have the force
of law, CongressDaily reports (Marshall-Genzer/Heil, CongressDaily,
4/28).
●
Los Angeles Times: The new policy addresses concerns raised by some
congressional Republicans and Democrats who said the previous rules were
unfair because drug plans could change their formularies as often as
they liked but beneficiaries could only change plans once annually, the
Times reports (Los Angeles Times, 4/28).
Broadcast Coverage
● NPR's "Morning
Edition" reported on the change to the Medicare prescription drug
benefit. The segment includes comments from Baucus and Lincoln and CMS
Deputy Administrator Leslie Norwalk (Rovner, "Morning Edition," NPR,
4/28). The complete segment is available
online in RealPlayer.
"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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