Low-income Medicare beneficiaries will have trouble getting medications in January 2007

Dec 5 2006

Some pharmacists and advocates have raised concerns that many low-income Medicare beneficiaries "will again have trouble getting medications next month, as they did in January of this year," when the Medicare prescription drug benefit began, the New York Times reports.

About 600,000 low-income Medicare beneficiaries who automatically received a subsidy to help cover their prescription drug costs this year will have to apply on their own to qualify for the funds for the 2007 plan year, which begins Jan. 1, 2007. According to the Times, some pharmacists and advocates have raised concerns that many of the affected Medicare beneficiaries "will not discover the change in their status until they show up at pharmacies next month" and are charged higher copayments. Medicare beneficiaries have until Dec. 31 to enroll in the prescription drug benefit or make changes to their plans. This year, several states established emergency programs to help Medicare beneficiaries who had problems with access to medications under the prescription drug benefit because of enrollment or other issues, but most states have ended those programs. Stan Rosenstein -- the Medicaid director in California, which will continue such an emergency program until Jan. 31, 2007 -- said, "We anticipated that there could be problems in January. So we kept the program available as a safety net." CMS officials said that they have taken steps to avoid the problems with the Medicare prescription drug benefit that occurred last January. CMS spokesperson Kathleen Harrington said, "Lessons have been learned." Mark Gregory -- a vice president for Kerr Drug, which owns 102 pharmacies in North Carolina and South Carolina -- said, "It can't be as bad as early this year. Some seniors will show up at the pharmacy, unaware they have been reassigned to a different plan" (Pear, New York Times, 12/5).

Additional Coverage
Two newspapers recently examined issues related to the ongoing open enrollment period for the Medicare prescription drug benefit. Summaries appear below.

• Reuters: Reuters examined revisions to Medicare prescription drug plans for 2007. According to Reuters, while the government says monthly premiums will average around $24 is 2007, "many plans are making big price changes and dropping some covered prescriptions" (Dixon, Reuters, 12/3).
  
  
• Wall Street Journal: The Journal examined a new tool on the Medicare Web site that allows beneficiaries to estimate their monthly and annual spending and determine whether or when they will reach the so-called "doughnut hole" coverage gap (Zhang, Wall Street Journal, 12/5).

VA 'Defections'?
In related news, CMS officials have promoted the Medicare prescription drug benefit by "pointing to defections" from a Department of Veterans Affairs program, but VA officials report "no signs, large or small, of folks leaving," the AP/Spokane Spokesman-Review reports. HHS Secretary Mike Leavitt recently said that "about a third of those who are on the Veterans Administration plan chose to enroll in a Part D plan." CMS spokesperson Jeff Nelligan said that almost 1.8 million veterans who previously enrolled in the VA program are enrolled in a Medicare prescription drug plan or receive coverage through their former employers, which receive tax breaks to provide the coverage to retirees eligible for Medicare. However, Mike Valentino, pharmacy director for the VA, said, "I've seen some of those comments about a million veterans leaving VA for Part D. Our data doesn't support that." Valentino said that about 4.3 million veterans received prescriptions through the VA program this year, compared with 4.1 million in 2005. According to the AP/Spokesman Review, the comments might indicate that almost two million veterans "are enrolled in both programs" (Freking, AP/Spokane Spokesman-Review, 12/5).