Mike's Weekly Message -Medicare Part D – A Flawed Drug Benefit

MIKE'S WEEKLY MESSAGE
Medicare Part D - A Flawed Drug Benefit

In November 2003, Congress passed sweeping legislation to create Medicare Part D, a voluntary prescription drug plan to provide coverage to 42 million elderly and disabled Americans who qualify for Medicare coverage. I did not support this legislation because I think that we can do better for our seniors. The bill contains language that actually states the Federal Government shall be prohibited from negotiating with the big drug manufacturers to bring down the high cost of medicine. Additionally, many seniors will experience a gap in coverage for necessary medications, referred to as the ‘donut hole,' during which beneficiaries pay their monthly premium for the prescription drug program, while paying the full cost of their medications.

While I did not support this legislation, Medicare recipients became eligible for the prescription drug coverage benefit on January 1, 2006 and deserve access to medications as promised by legislation signed into law in 2003. Suffice it to say, after over two years of preparation, I am extremely disappointed that a number of problems have cropped up immediately and beneficiaries are being denied access to medications upon which their lives depend.

Perhaps the biggest problem with the Medicare Part D prescription drug benefit launched just weeks ago is the group of beneficiaries referred to as the dual eligible population; those eligible for both Medicare and Medicaid coverage. As of January 1, 2006, Medicaid beneficiaries were supposed to have their prescription drug benefit shifted to the Medicare Part D prescription drug coverage. Unfortunately, there has been a huge snafu in the electronic system in that Medicaid beneficiaries are not in the system at all or have been wrongly classified as a standard Medicare beneficiary and are subsequently being charged significantly higher co-payments than what is allotted for a Medicaid beneficiary.

As a result, pharmacists across the country are faced with a dilemma. They must either deny necessary prescriptions to Medicaid beneficiaries or the pharmacists must absorb these out of pocket expenses to pay for the cost of the prescriptions while kinks in the system are being ironed out and they are hopefully reimbursed. Either way, an unfair fiscal burden has been placed on the shoulders of both Medicaid beneficiaries and pharmacies throughout the country by a federal program that had two years to prepare.

In a bipartisan manner, I have joined Senators Blanche Lincoln and Mark Pryor, along with U.S. Representatives Marion Berry, Vic Snyder, and John Boozman in sending a letter to Mark McClellan, the Administrator of the Centers for Medicare and Medicaid Services (CMS), requesting his immediate attention to this serious problem facing Medicaid beneficiaries throughout the country.

I commend the Attorney General and the Governor of Arkansas for their efforts in authorizing the Arkansas Department of Health and Human Services to reimburse the State Medicaid program so that pharmacists are allowed to bill Medicaid - as they did just weeks ago - for prescription drugs for dual eligibles either incorrectly identified or not at all in the system. At least four states - Maine, New Hampshire, Vermont, and North Dakota - have instituted this plan. Taking this one step further, I have sent an additional letter to Mark McClellan, requesting that Medicare reimburse states for Medicaid costs incurred while problems in the new Medicare Part D prescription drug plan are being ironed out. Such action would ensure that beneficiaries receive their medications in a timely and effective manner, as well as relieve the fiscal burden that they and pharmacists are facing.

As your Representative in the United States Congress, I will always side with the people I represent in Arkansas's Fourth Congressional district and continue to be your voice in our nation's capitol. I look forward to what will hopefully be a timely response and adequate solution from CMS. Access to life saving medications should not be limited, and I will continue to work to ensure that all citizens have fair access to the Medicare Part D prescription drug benefit.

http://www.house.gov/apps/list/hearing/ar04_ross/newsletter_011306.html