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Administration Tells Insurers To Honor Medicare Rx Claims

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The Bush administration is requiring insurers to provide needed drugs to Medicare beneficiaries while startup problems in the new pharmacy benefit are resolved.

The problem has already been confronted at the state level. Around 20 states have taken measures to ensure beneficiaries will be able to receive their prescription drugs. Some states declared the situation a public health emergency, and others said their state would pay for prescription drugs that should be covered by the federal program.

“We understand the federal government is working hard to correct the problems with this new prescription drug program, but the fact is that a lot of vulnerable Ohioans who expected affordable copayments for their prescriptions are not getting the benefit that they were promised,” said Ohio Governor Bob Taft. “Until the problem is fixed, we are doing what we can to help our citizens afford their medications.”

Illinois Gov. Rod Blagojevich said it was “unacceptable” that problems in the system could result in seniors being unable to fill their prescriptions. “Hopefully, the glitches with the federal program will be worked out soon, but until then, we’re going to take care of those who need their prescription drugs to remain healthy,” he said.

The federal requirement would ensure seniors have a 30-day supply of any drug they had been taking previously, and it mandates poor seniors cannot be charged more than $5 for their prescriptions.

AARP chief executive officer Bill Novelli said that “clearly there are problems” with the drug benefit implementation, and the AARP is taking those problems seriously.

“Some people are not getting the drugs they need,” he said. “This is unacceptable. If an individual has proof of eligibility, there is absolutely no reason they should pay more than required or leave a pharmacy empty-handed.”

In an interview with the Associated Press, Dr. Mark McClellan, head of the Center for Medicare and Medicaid Services, acknowledged the problems and said the agency is trying to resolve them.

“I’m working with the states, with the plans, with all of our partners to make sure people get the prescriptions they need,” he said.

McClellan has attributed much of the problems in starting up the Medicare Part D drug benefit to a surge in the number of participants signing up for the program. The Center has been working to resolve the problems, he told the New York Times, adding that with the agency’s recent actions, “all beneficiaries should be able to get their prescriptions filled.”


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