Medicare Compliance & Reimbursement

Rocky Part D rollout leaves many without prescription drug access

While system glitches leave many Part D beneficiaries without access to their prescription drugs, states are stepping up to protect their own--at considerable cost.

In spite of the Centers for Medicare & Medicaid Services' comprehensive contingency plan, millions of dually eligible benes transferring from Medicaid drug coverage to Medicare Part D have had problems filling their prescriptions since the plan began Jan. 1. As state officials had feared, bewildered benes are turning to Medicaid for answers.

Lacking coverage and subsidy eligibility records are among the most common problems benes have reported. Many pharmacists are unable to find Part D enrollment records for benes trying to fill their prescriptions, while others end up overcharging low-income benes who, according to the system, aren't eligible for drug subsidies.

Nevertheless, pharmacists around the country are filling a million prescriptions a day, and many seniors are reporting that they are already saving money from the benefit, say CMS and Department of Health and Human Services secretary Mike Leavitt. But Leavitt acknowledges that some seniors are experiencing problems getting pharmacies to fill their prescriptions. "We are working as quickly as possible to resolve these problems, and no senior should leave the pharmacy without the prescription drugs they need," he says.

States Step In To Bridge The Gap

At least 26 states have already stepped in to offer immediate prescription protection and fulfillment to dual eligibles, allowing pharmacists to bill state programs directly. States leading the movement include Arkansas, California, Connecticut, Illinois, Kansas, Maine, Massachusetts, New Hampshire, North Dakota, South Dakota and Vermont.

Those states that enact measures to extend drug coverage to Medicare benes may not receive federal reimbursement for their efforts, however. "Under this program, [CMS doesn't] have the authority to pay states directly," notes CMS Administrator Mark McClellan. "People are in Medicare drug plans and it's the Medicare plans that are supposed to pay for the medications."

"That kind of defies the old good-neighbor rule," complains Gov. Mike Huckabee (R-AR). "They borrowed our lawn mower, and they gave us back a pair of scissors." Many state officials have expressed similar sentiments, vowing to press Washington for reimbursements. In addition, a bipartisan senate group plans to sponsor legislation that forces CMS to reimburse states for 100 percent of their Part D-related costs, plus interest. The legislation would also require HHS to recover overpayments to Part D drug plans and return the money to Medicare.

In CMS' own effort to ensure enrollees receive their prescriptions, the agency directed Medicare carriers to provide benes with a 30-day emergency supply of any drugs they were taking before the Medicare prescription drug benefit began Jan. 1. CMS also requires carriers to take steps to prevent low-income benes from [...]