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Cantwell Demands Help for Seniors Left Behind by New Medicare Drug Program

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Location: Seattle, WA


Cantwell Demands Help for Seniors Left Behind by New Medicare Drug Program

Sickest and poorest assigned to plans at random; now discover their plan doesn't pay for the life-saving medications they need Senator Continues Call for Extension of Enrollment Deadline for Drug Plan

Sunday at the Kelley-Ross Pharmacy, U.S. Senator Maria Cantwell (D-WA) demanded that the Centers for Medicare and Medicaid (CMS) cover all beneficiaries left without life-saving drugs due to haphazard implementation of the new Medicare Prescription Drug Plan.

"The administration is leaving behind our sickest and poorest," said Cantwell. "We simply cannot sit by and pretend the new Medicare prescription drug program is working when the seniors who need help most are forced to go up to a month without the life-saving drugs they need."

Seniors eligible for both Medicare and Medicaid are often those with chronic illnesses and with the lowest incomes. These "dual eligibles" were automatically assigned to drug plans based on zip code, with no regard for which plan would actually fit them best. Dual eligibles who decide to switch plans are not covered by the new plan until the first day of the following month, leaving many without access to medications for up to 30 days. In many cases, dual eligibles have encountered higher premiums and problems changing plans, leaving them without necessary medicine for even longer.

"Patients around the country and in Washington state are scrambling to find ways to get the medicine they need," said Cantwell. "Right now, pharmacists are absorbing the cost of giving medicine to these desperate customers. We need to do better."

In a letter sent to the Department of Health and Human Services, which oversees CMS, Cantwell called on the agency to ensure all dual eligible beneficiaries are given a 30-day supply of needed medication to last them until their new plan takes effect. Cantwell also continues to demand an extension of the May 15, 2006 deadline for enrollment in the new Medicare Prescription Drug Plan, and has co-sponsor the Medicare Informed Choice Act (S. 1841) to extend the enrollment period through all of 2006. Without an extension, many seniors may not have enough time to sort through the maze of available information to determine which plan fits them best.

In order for the new prescription drug program to work, 20 to 25 million seniors would have to enroll, according to the National Council on Aging. The larger the number of enrollees, the more the insurers will be able to spread risk and keep costs down. The Administration estimated that 29 million of Medicare's 43 million beneficiaries would sign up for the plan. With time running out, only 10 million seniors have enrolled.

Seniors requiring help understanding their options under the Medicare program can call the State Health Insurance Assistance Program at 1-800-562-6900. Please know that it could take several days for a call to be returned.

[The text of Cantwell's Letter to the Department of Health and Human Services follows below]

January 15, 2006

The Honorable Michael O. Leavitt Secretary Department of Health and Human Services 200 Independence Avenue, SW Washington, DC 20201

Dear Mr. Secretary,

As you know, last week marked the beginning of the Medicare Prescription Drug Plan. I understand that the Centers for Medicare and Medicaid Services have been working to make implementation of this program as seamless as possible. Unfortunately, I still have concerns over many aspects of the program.

I am alarmed about stories I have heard in my home state of Washington. Local pharmacists are working around the clock, SHIBA volunteers are putting in extra hours, and yet our most vulnerable beneficiaries—those dually eligible for both Medicare and Medicaid—are still bearing the brunt this program's problems. There are 96,000 such beneficiaries in Washington that face potential gaps in prescription drug coverage and that is simply unacceptable.

Many clients remain confused as to what plan they were assigned to or how to contact their plan. Pharmacies have faced numerous barriers such as busy phone lines and crashing websites when trying to verify enrollment information. Although prescription drug plans have been instructed to accept a client's word that they are eligible for both Medicare and Medicaid, many are still being charged the deductible of $250 and co-payments that are simply out of reach for this low-income population.

I've also heard of many beneficiaries eligible for both Medicare and Medicaid that were unable to obtain life-saving medications because they have been randomly assigned to a plan that does not meet their unique health needs. Although there is a requirement for prescription drug plans to provide a 30-day transitional prescription, many seem to be unaware of the requirement or are unwilling to do so. This leads to beneficiaries either leaving empty-handed or to the pharmacy dispensing the medication without knowing how or when they'll be reimbursed. This is particularly onerous for our smaller, independent pharmacies.

While I understand that CMS is currently working to address these problems, I specifically ask that you:

• Address how you plan to reimburse dual eligible clients that have been incorrectly charged the $250 deductible and the higher copay amount. • Take steps to ensure that prescription drug plans are indeed approving a 30-day supply of medication during the transition or appeals process for dual eligibles. • Explain how pharmacies that have provided prescriptions to dual eligibles during transition period will be reimbursed. • Report the number of beneficiaries eligible for both Medicare and Medicaid nationwide, and in Washington, that have experienced problems in getting their medications.

I hope that you will address my concerns with urgency and ensure that all beneficiaries receive their needed medications without experiencing a dangerous lapse of coverage. Thank you for your attention to this request.

Sincerely,

Maria Cantwell United States Senator

cc: Dr. Mark McClellan, MD Administrator, Centers for Medicare and Medicaid Services

http://cantwell.senate.gov/news/record.cfm?id=250669&&days=30&

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