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Wilson Concerned About Medicare Drug Coverage for Low-Income Seniors

Location: Albuquerque, NM

Wilson Concerned About Medicare Drug Coverage for Low-Income Seniors

Albuquerque, NM - U.S. Congresswoman Heather Wilson expressed concerns today with how the federal government is implementing the new prescription drug benefit. Specifically, Wilson's concern stems from problems that seniors with the lowest incomes have had during the first two weeks of implementation of the plan. Those seniors qualify for both Medicare, which provides healthcare to those over 65, and Medicaid, which provides healthcare to low-income New Mexicans. Wilson wants to ensure that no senior leaves a pharmacy without filling their prescriptions.

The Honorable George W. Bush
President of the United States
The White House
1600 Pennsylvania Avenue Northwest
Washington, D.C. 20500

Dear Mr. President,

The passage of the Medicare Part D prescription drug benefit is the most significant change in Medicare since its inception. I have been monitoring the implementation and information provided to constituents regarding the program for some time, holding meetings at Senior Centers, helping constituents with their questions and providing information directly to seniors about the plan. Because this new benefit affects thousands of New Mexicans at one time, there have been many questions and concerns. With the benefit beginning on January 1, 2006, we have been monitoring implementation of the program so that we can address any concerns.

Since the Medicare prescription drug benefit started on January 1, 2006, we have heard about some constituents not getting the drugs they need from the pharmacy or being charged co-payments far above what they should be charged and above what they can afford. Medicare took steps to improve the transition to the new Medicare Prescription Drug Benefit by requiring prescription drug plans to provide at least a 30-day supply of all prescriptions after a senior is first enrolled and by creating a process of facilitated enrollment for dually eligible seniors if they were not automatically enrolled and requiring pharmacies to provide all of their medications at no more than a $5 co-payment until they are enrolled. While these policies help in the transition, I am concerned about their implementation and enforcement by Medicare. Based upon this policy no one should leave the pharmacy without their medications, yet I have been told that people are leaving pharmacies without their prescriptions.

While some pharmacies are trying to work within the policy, they have reported getting conflicting information from CMS and great difficulty getting through to CMS to work through the problems. Ultimately it is the constituent that may be hurt by this process if their prescription is not filled. CMS has been given ample time and resources to ensure the smooth implementation of this program. I would ask that you take the action necessary to get answers to people so that they can fill their prescriptions- including better manning of CMS help-lines.

Pharmacists have expressed concern about the lack of updated information on plan enrollment in the E1 electronic information system they access. They have also had difficulty accessing the information through the dedicated Medicare pharmacist phone lines and the phone lines of individual prescription drug plans due to high volume and inadequate staff resources. Medicare has the ability, through its contracts, to enforce better service through the prescription drug plans to increase call volume capacity and update enrollment information. Again, with the length of time that was available for training, education, and planning implementation, glitches in this process should have been worked out long in advance. I would ask that you expeditiously ensure that the data is updated rapidly for pharmacists to verify eligibility.

At the same time, you should know that today I had the opportunity to visit a call center in my district that is handling a large percentage of the customer service calls for one of the national plans. Their experience is that the call volume for the first week in January was very high, with lots of frustrated people in states that did not send notification to dual eligible patients of the company they were enrolled in until late in December. The call volume decreased in the second week and is down substantially today. I hope that this indicates some of the initial problems are being worked out.

Access to health care and prescription drugs for seniors and other Medicare eligible constituents should be the first priority of CMS. I would ask that CMS take every step necessary to solve these problems and ensure that seniors have access to the drugs they need during this transition period. Additionally, I would ask to be kept informed of your progress in addressing the concerns and problems faced by my constituents.


Heather Wilson
Member of Congress

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