Medicare Compliance & Reimbursement

Agency releases more details on oft-misunderstood drug-card policies.

When Medicare prescription-drug discount cards launch early this summer, the Centers for Medicare & Medicaid Services Web site will become a mecca for price-conscious consumers in and out of Medicare, Health and Human Services Secretary Tommy Thompson said Feb. 25.

CMS will publish the current price each card offers for each drug and will update the information weekly. Thus, the Web site will "add complete transparency to the prescription-drug market," giving health plans and younger consumers, as well as Medicare beneficiaries, the knowledge needed to push for lower prices, Thompson told the National Medicare Prescription Drug Congress.

Thompson is pushing an "aggressive timeline" on making the cards operational and said he'll announce which cards Medicare will endorse by March 20 or earlier if possible. Card sponsors will market their cards in April with beneficiary signup slated for May and discounts to begin June 1.

Out of 106 entities that initially applied to CMS to be card sponsors, two have withdrawn their applications, said Thompson. Fifty-five of the now 104 applicants propose offering cards to the general Medicare population; the rest generally are connected to Medicare Advantage health plans and would offer cards to plan enrollees.

To choose the right card for them, Medicare beneficiaries can check the Web to compare prices for drugs they take or call a telephone help line to get the same information. Some manufacturers offer their own drug discounts, and that information also will be available on the site, Thompson said.

For example, Merck & Co. Inc. has announced it will offer its drugs free to beneficiaries with incomes below 135 percent of the federal poverty level after they've exhausted the $600 in annual federal assistance for which they qualify along with the drug cards. The company will provide its medicines free to beneficiaries' discount-card plans. A dispensing pharmacy may then "charge the beneficiary a fee consistent with its contractual arrangements with the discount-card sponsor for processing, dispensing, and counseling services." Merck won't get any of those pharmacy fees, says a company press release.

"I am confident that this will lead to lower prices from other companies," Thompson said.