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Life Health > Health Insurance > Medicare Planning

HHS Promises To Watch Drug Plans More Closely

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The U.S. Department of Health and Human Services says it will be giving more attention to customer service and claim payment speed at the private insurers that are helping to run the new Medicare Part D prescription drug program.

Many governors, representatives and senators have been complaining about enrollment delays, payment delays, difficulties reaching customer service centers and other startup problems at the new program, especially for low-income Medicare beneficiaries who also qualify for Medicaid. Those “dual eligibles” were automatically enrolled in the Part D program.

Other Medicare beneficiaries are supposed to sign up for Part D coverage by May 15 or may have to wait to join the program.

Sen. Rick Santorum, R-Pa., said Thursday at a hearing organized by the Senate’s Special Committee on Aging that the Medicare drug program is having problems mainly because of the many compromises needed to get the program proposal through Congress.

Congress took 20 years to pass a Medicare drug plan bill, and lawmakers should avoid throwing the baby out with the bathwater because of concerns about startup problems, Santorum said.

Mark Ganz, president of the Regence Blue Cross Blue Shield, Portland, Ore., reported that the Medicare drug plan will help his own mother cut her drug expenditures to about $3,000 this year, from $8,000 in 2005.

Regence has taken aggressive steps to address problems with automated enrollment of dual eligibles as well as unexpectedly heavy demands on customer service centers, Ganz said.

“One lesson we’ve learned at Regence is that we cannot over-communicate in a program of this scope and complexity,” Ganz said. “With this population, there is no substitute for one-on-one – preferably face-to-face – communication.”

But Ganz said he believes working out the drug plan implementation problems will help millions of Medicare beneficiaries get better, more affordable drug coverage.

But many senators on the committee, especially Democrats, said Medicare plan officials have to take the startup problems seriously.

“It’s bedlam out there,” said Sen. Ron Wyden, D-Ore.

“The program as implemented today is just too confusing,” said Sen. Thomas Carper, D-Del. Carper noted that he voted for the program but has been disappointed by the implementation.

Sen. Bill Nelson, D-Fla., spoke of seeing tears streaming down the faces of senior citizens who came to town hall meetings to talk about problems with Medicare drug benefits.

Many Florida Medicare beneficiaries who are still deciding whether to sign up for Part D coverage “are not only confused, they’re frightened,” Nelson said.

Some senators mentioned the possibility of scrapping the drug program, and several senators seemed to be framing the discussion as a story about a battle pitting patients, physicians and community pharmacists against the new drug plans.

Sen. Hillary Clinton, D-N.Y., mentioned reports from constituents about drug plans that require physicians to fill out 14-page preauthorization forms.

In starting the Medicare drug program, “we have taken tax dollars by the billions and transferred them to the pharmaceutical companies and the insurance companies,” Clinton said.

Shortly before the start of the hearing, HHS Secretary Mike Leavitt announced a plan for improving Medicare drug program administration.

One step will extend the drug program’s transition coverage period to 90 days, from 30 days. The extension means drug plan members who are asked to switch drugs will have extra time to see whether it is safe for them to take the drugs on their new plans’ “formularies,” or preferred drug lists, according to HHS officials.

HHS also has reduced the call wait time for its own Medicare drug customer service hotline to less than 1 minute, from about 5 minutes in early January, HHS says.

Most private Medicare drug plans already have taken steps to reduce wait times for customers and pharmacists to acceptable levels, but “HHS will increase its monitoring and reporting of drug plan wait times and will take corrective actions in the specific cases where plans do not improve,” HHS officials say.

Medicare administrators also are trying to improve drug program administration by improving data translation between Medicare, health plans and states, and “assuring plans meet contractual payment terms for pharmacies,” officials say.

During the Senate committee hearing, senators talked about the possibility of relaxing the May 15 Part D enrollment deadline and easing financial burdens on dual eligibles.

Carper and Wyden recommended that HHS adopt a small number of standard Medicare drug plan types, to help consumers make the same kinds of comparisons that consumers now make in the Medicare supplement insurance market.

Mark McClellan, administrator of the Centers for Medicare and Medicaid Services, said CMS was not in a position to create standard plans when it planned the Part D program because it was not sure then whether private insurers would be interested in participating.

Now that the program is up and running, competition probably will lead to simplification of the drug plan program, McClellan said.


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