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CMS to Make Beneficiaries' Drug Plan Complaints Public

By Mary Agnes Carey, CQ HealthBeat Associate Editor

June 29, 2006 -- Starting in mid-July, the Centers for Medicare and Medicaid Services will make public Medicare beneficiaries' complaints about their Medicare prescription drug plan.

The complaints, which could include not responding to requests for appeals or drugs covered, would be reported on a percentage basis as related to a plan's total enrollment, said CMS spokesman Peter Ashkenaz.

In the past month, the agency said it has received approximately 2.2 complaints per 1,000 Medicare beneficiaries enrolled in prescription drug plans, with most complaints involving enrollment or disenrollment in a plan, difficulty in getting needed drugs and the cost of drugs or copayments, CMS said in a news release.

CMS also announced late Wednesday it has taken more than 1,000 compliance actions against drug plans this year. In 651 cases, CMS issued warning letters to plans for topics such as posting errors on Medicare's "Personal Plan Finder." CMS also issued 152 notices of non-compliance for problems such as failing to meet call center performance requirements, and the agency issued 318 requests for specific business plans on topics such as improving call center performance.

CMS did not release the names of the companies involved because "in the vast majority of cases, the problems were resolved quickly," Ashkenaz said.

When problems were not fixed fast, CMS took further enforcement actions. In 75 cases, CMS temporarily restricted plan marketing by removing information about the drug plan from the Medicare plan finder.

Some consumer advocates said CMS should release the names of sanctioned plans. "Public disclosure of identified problems makes sense if you're concerned about the informed consumer or the public interest," said Robert M. Hayes, president of the Medicare Rights Center. "If your main priority is propping up an industry and make it look better than it's performing, of course you don't want to disclose the culprits."

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