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Johnson Steps Gingerly into Drug Benefit Oversight Role

MARCH 31, 2006 -- House Ways and Means Health Subcommittee Chairwoman Nancy L. Johnson, R- Conn., sent a letter to the head of the Medicare program Thursday questioning him on various aspects of the sometimes troubled drug benefit enrollment process, a move into oversight Democrats say should have happened months ago.

The letter avoided criticism of Medicare's handling of the drug benefit while asking some two dozen specific questions seeking details on how the program is handling various aspects of implementation.

Some of the questions sought information on issues that the Centers for Medicare and Medicaid Services has either addressed publicly in the past or on issues that cropped up weeks ago, while others appeared aimed at ensuring proper planning for events already occurring or about to occur. Still other questions were more forward-looking, about whether Medicare is planning properly for future periods of heavy enrollment.

Johnson is facing what analysts say is a serious reelection challenge from Democrat Chris Murphy, a Connecticut state senator from New Britain. Murphy called for sweeping changes in the Medicare drug benefit in mid-March, calling it overly complex and confusing and naming reform of the program as one of his top priorities if he is elected to Congress.

In her March 27 letter to CMS Administrator Mark B. McClellan, Johnson praised CMS for its efforts, saying "premiums are very affordable and many seniors are realizing many thousands of dollars in savings."

The Medicare enrollment period for this year ends May 15. Johnson noted, "I know CMS is preparing for 2007 by updating and improving on your current educational materials. Continued success will depend on the availability of educational materials and assistance. Only clear and timely information will enable beneficiaries to enroll in the plan most useful to them."

Among Johnson's questions are: how CMS has expanded the annual handbook sent each fall to Medicare beneficiaries to reflect the new drug benefit, what the average wait times are for consumers calling the 1-800-Medicare consumer information line, and what the wait times are for pharmacists calling Medicare.

"As many as 700,000 [dual eligible] and low-income beneficiaries are utilizing one plan when CMS has a different plan as their 'plan of record,'" the letter said. "How is CMS addressing this situation?"

The New York Times first reported on the problem in a March 1 story. Complaints from pharmacists and beneficiaries about wait times surfaced months ago.

Johnson's March 27 letter also asked about CMS planning for the April 1 start of formularies taking effect for drug beneficiaries limiting or ending coverage of some drugs. "Are the plans prepared to implement the appeals process. Are forms easily available?" She also asks about planning farther down the road: "Are you prepared for a surge of sign-ups before the May 15th deadline, and what steps have you taken to be sure the plans are prepared?"

Johnson requested responses "no later" than April 21, saying "we intend to hold a hearing on implementation of the Part D benefit to focus on the steps CMS is taking to encourage beneficiaries to sign up." No date has been set for the hearing.

"The fact that they don't know the answers to these questions already shows how little oversight they have done," said a Democratic aide. "I think we know the answers to most, if not all, of these questions." The aide added that the questions "fail to get at many of the real problems," naming as examples difficulties of dual-eligibles getting prescriptions filled and ensuring access to drugs in drug classes required to be covered.

Phone calls seeking comment from Johnson aides were not returned.

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