JANUARY 12, 2006 -- One of the two Democrats who helped write the Medicare prescription drug law has criticized its implementation and urged federal officials to quickly fix what he sees as an array of problems with the benefit that began Jan. 1.
Sen. Max Baucus of Montana, the ranking Democrat on the Senate Finance Committee, said on Thursday that he was "disappointed and extremely concerned" with the transition of dual-eligibles—Medicare beneficiaries who also qualify for Medicaid—from Medicaid to Medicare drug coverage, by the Centers for Medicare and Medicaid Services (CMS).
"CMS has failed to adequately protect these beneficiaries," Baucus wrote in a letter to Health and Human Services Secretary Michael O. Leavitt. Baucus cited a series of problems from both his home state and around the country as well. They include low-income Medicare beneficiaries being charged copayments that are far higher than those established by Congress and low-income seniors being required to pay the full Medicare drug plan deductible of $250 although the drug law (PL 108-173) does not require them to do so.
Baucus' complaints add to the growing chorus of criticisms from lawmakers and some consumer watchdog groups over how the government and private health care plans have handled the first weeks of the new Medicare drug benefit. Sen. Hillary Rodham Clinton, D-N.Y., said on Thursday that her office had been "deluged with complaints from frustrated and confused beneficiaries, pharmacists, and other providers struggling in this transition." On Tuesday, Rep. Benjamin L. Cardin, D-Md., urged Leavitt to add additional staff to the 1-800-Medicare line to help pharmacists verify beneficiaries' eligibility for the benefit. On Dec. 30, two days before the drug program began, Sen. Olympia J. Snowe, R-Maine, said that CMS's computerized database contained inaccurate information on roughly half of the state's dual-eligibles.
On Thursday, the Center for Budget and Policy Priorities, a liberal-leaning think tank, heavily criticized the startup of the Medicare drug benefit.
In an interview taped for C-SPAN that airs this weekend, CMS Administrator Mark B. McClellan said on Thursday that there were problems with coverage for some dual eligibles. But he added that difficulties were often limited to duals who switched their plan coverage late in December, which complicated efforts to have their data correctly entered into CMS computers in time for the start of the drug benefit.
"We're handling the cases where it comes up," McClellan said. "We will continue to watch this very carefully." He added that most beneficiaries who enrolled in the drug benefit were receiving their prescriptions. "Many pharmacies are having no problems at all. Many states are having no problem at all," McClellan said.
According to Baucus, about 10 states have responded to problems with the drug benefit by restarting Medicaid prescription coverage, even though the states are ineligible for matching federal Medicaid payments. In the C-SPAN interview, McClellan said that CMS did not have the authority to reimburse states for such payments.
In his letter, Baucus wrote that many problems with the drug benefit rollout "appear to stem from CMS' over-reliance on the efforts of community pharmacists" to move the approximately 6 million dual-eligibles from Medicaid to Medicare for their drug coverage. CMS computer systems designed to help pharmacists accomplish that goal "have repeatedly failed," Baucus wrote, adding that pharmacists report errors and shutdowns in CMS-contracted software and busy signals and long waits on the 1-800-Medicare line. "In some cases, pharmacists are simply giving prescriptions away when they do not know how to correctly bill," Baucus wrote.
"In short, Part D has experienced major setbacks in its first week," Baucus concluded. CMS, he said, must improve its information technology systems to speed beneficiary enrollment in the drug benefit and electronic verification of that enrollment for pharmacists.