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Insurers: No Problem Filling Part D Gaps

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Health insurers have offered no resistance to a White House mandate last week that they provide prescription drugs to seniors in an effort to fill any gaps as the Medicare Part D drug benefit takes effect.

“We’re very comfortable with what the administration is requiring,” said Karen Ignagni, president of America’s Health Insurance Plans, about the Bush administration’s order that insurers provide seniors with a 30-day supply of any drug they had been taking previously. In addition, the White House said insurers would be barred from charging low-income Medicare beneficiaries any more than $5 for their prescriptions.

The problems in verifying that beneficiaries were enrolled in the new Part D drug benefit had grown to the point that many states felt compelled to take action on their own. About 20 states acted to ensure that seniors were provided with the prescription drugs they needed. Some states declared the situation a public health emergency, and others said they would pay for the 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 co-payments 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.”

AARP CEO Bill Novelli said “clearly there are problems” with the drug benefit implementation and that those problems are being taken seriously by the AARP.

“The bottom line is that 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 [he or she] should pay more than required or leave a pharmacy empty-handed.”

In an interview with The Associated Press, Dr. Mark McClellan, head of the Centers for Medicare and Medicaid Services, which administers the programs, acknowledged the problems and said the agency is working to resolve them.

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

McClellan has attributed much of the problem in starting up the Medicare Part D drug benefit to a surge in the number of participants signing up for the program just before it took effect on Jan. 1, 2006.

Ignagni said health plans had been told they would be responsible for some “transition” and that the requirements “are very consistent” with what the CMS had been saying last month and during the fall.

“CMS has been working 24 hours a day,” to get the updated beneficiary files to health insurers, she said. In fact, she noted that insurers already had received the files for “dual-eligible” beneficiaries who qualify for both Medicare and Medicaid assistance. The files for other low-income beneficiaries, she said, were expected by the end of last week.

Once insurers received those files, she said, “the system will be able to work in real time.”


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