The federal government has agreed to reimburse at least 20 states that have been providing emergency medicines for low-income seniors and disabled people who could not get help from the new Medicare Part D system.
The prescription drug insurance program was supposed to be up and running by Jan. 1, but states have stepped in because an estimated 10% to 20% of eligible beneficiaries were unable to get medicines through the program.
Some beneficiaries failed to show up in pharmacists’ computers as being enrolled in a plan. On other occasions, beneficiaries were charged fees for their medicine that far exceeded what they were supposed to pay, state officials say.
“These states need to be reimbursed for costs that they have put out on behalf of the plans,” U.S. Health and Human Services Secretary Mike Leavitt said earlier this week.
HHS is not yet saying how much it will spend to reimburse the states, but officials say they expect private plans to cover the majority of the reimbursement costs.
The HHS reimbursement plan calls for the federal government to help states collect from the drug plans that were supposed to be taking care of low-income beneficiaries.
Washington also will cover the states’ administrative costs plus any difference between what pharmacies charged the states and rates the drug plans pay to pharmacies.
Lawmakers have introduced a bill that would require that states be reimbursed for picking up the tab for Medicare beneficiaries, but Mark McClellan, administrator of the Centers for Medicare and Medicaid, says no congressional action is needed to authorize the reimbursement program. He says he expects most states to shut down their emergency assistance efforts by Feb. 15.
“We will ensure the plans reimburse the states and pay for any difference,” McClellan says.