January 9, 2006
Arkansas Delegation Calls on CMS to Fix Operational Problems of new Medicare Benefit
Washington, DC - After receiving numerous complaints from pharmacists and Medicare beneficiaries throughout Arkansas, Senators Blanche Lincoln, and Mark Pryor, along with U.S. Representatives Marion Berry (AR-01), Vic Snyder (AR-02), Mike Ross (AR-04), and John Boozman (AR-03), sent a letter to Mark McClellan, Administrator of the Centers for Medicare and Medicaid Services (CMS), requesting his immediate attention to a number of operational problems with the new Medicare Part D prescription drug benefit. These setbacks make it difficult for pharmacies to provide continuous drug coverage and prevent many patients from receiving necessary prescriptions.
The operational problems began on January 1, 2006, when pharmacists tried to use the CMS database to deliver prescriptions to Medicare recipients. Pharmacists struggled to find patient information in the overwhelmed and incomplete database, which is lacking information on some individuals eligible for both Medicare and Medicaid, and does not recognize low-income subsidy patients. As pharmacists are unable to locate a patient's plan, they are either turning people away or providing prescription drugs at no charge.
Some Prescription Drug Plans (PDPs) are adding to the confusion by refusing to fill prescriptions for dual eligible enrollees whose drugs are not covered under plan formularies. This is a direct violation of the CMS regulations which require private plans to provide continuous drug coverage during this transition.
The Arkansas Delegation is also calling on CMS to clarify language that may conflict with Arkansas state law by allowing Long Term Care facilities to contract with a single Long Term Care pharmacy on behalf of all its residents. However, Arkansas state law protects a nursing home patient's right to choose their own pharmacy.
A copy of the letter is provided below.
January 9, 2006
Mark McClellan, M.D., Ph.D.
Centers for Medicare and Medicaid Services
314G Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, DC 20201
Dear Dr. McClellan,
We are writing on behalf of our constituents to express our concern with the implementation of the Medicare Part D prescription drug benefit. We believe that the Centers for Medicare and Medicaid Services (CMS) should immediately address serious operational problems which are leaving many Medicare beneficiaries without necessary prescriptions.
Those most severely affected are the dual eligible population, people with both Medicare and Medicaid. We are concerned that the safety net created by CMS to ensure all dual eligibles were able to receive their medications has fallen short. Specifically:
1. The electronic database has in many cases been unable to handle queries from pharmacists trying to find out which plan dually eligible beneficiaries are enrolled in.
2. Pharmacists are often unable to process prescriptions for dual eligibles who switched from their original plan. Patient information is not being updated in such cases, and pharmacists are unable to locate the new plan or receive reimbursement.
3. Some Prescription Drug Plans (PDPs) have refused to fill initial prescriptions for new enrollees that are not covered under their formularies. However, all plans were required by CMS to have policies to transition new enrollees and ensure continuous drug coverage. PDPs are unaware or are ignoring this requirement, leaving pharmacists with the dilemma of turning away beneficiaries or giving away medicines for free.
4. The database is also failing to recognize eligibility for the Low Income Subsidy (LIS) program, meaning that enrollees in this group are charged substantially more than they are supposed to pay for drugs. Clearly there needs to be accurate classification of the various beneficiaries served under the new program.
In addition, we request that CMS immediately address a problem unique to our constituents in Arkansas. A Long Term Care (LTC) guidance document issued by CMS on March 16th, 2005, states, "We expect that each LTC facility will select one or possibly more than one eligible NLTCP to provide Medicare drug benefits to its residents. A facility can continue to contract exclusively if it chooses, however, the features to promote competition . . . will likely give each facility access to a broader range of potential LTC pharmacies than is the case today." We believe this guidance to be inadequate and ask CMS to promptly clarify the intent on a patient's right to choose a pharmacy when such a right exists under state law.
We thank you for your attention to these matters and look forward to your prompt response.