Medicare Compliance & Reimbursement

It's official--Part D desperately needs changes.

Despite recent statistics showing that many health care industry leaders believe that Part D is good for beneficiaries, even more industry leaders want to see fundamental changes in the system.

Two thirds of respondents to a recent Commonwealth Fund Health Care Opinion Leaders Survey said that Medicare Part D was good for beneficiaries, but just 30 percent said that making Medicare drug coverage available only through private plans was good for enrollees. Approximately 36 percent believe that "the current benefit structure--including a 'coverage gap' during which most enrollees are responsible for all of their covered costs--will, on balance, help beneficiaries who are most vulnerable to high drug costs," according to a July 14 Fund statement announcing the survey's release.

Of the 180 survey respondents:

• 51 percent favored extending the enrollment deadline and removing the penalty;
• 39 percent favored leaving the deadline in place, but allowing individuals to enroll in the program next year without penalty;
• 77 percent favored standardizing benefits to reduce variation among plans; and
• 69 percent favored providing beneficiaries with better information on cost sharing and formulary structure.

According to the survey, most opinion leaders supported additional Part D policy changes, such as:
 
• Allowing plans to offer prescription drug coverage through the coverage gap as an option to the enrollee, with an extra premium and without extending the catastrophic threshold (79 percent);

• Filling in the doughnut hole with increased co-payments and additional government funding (71 percent);

• Raising the qualifying income level for a low-income subsidy (62 percent);

• Eliminating the asset test to qualify for low-income subsidies (57 percent);

• Offering a package that combines all Medicare benefits as an alternative to supplementing basic Medicare coverage with both a private drug plan and Medigap insurance (78 percent); and

• Offering an alternative option for drug coverage through traditional Medicare, in addition to Part D.

Approximately 82 percent of respondents "favor giving Medicare the authority to negotiate drug prices," the survey says. Only 2 percent said that Part D "should be left as it is," surveyors report.

To view the Fund survey, go to www.cmwf.org/surveys/surveys_show.htm?doc_id=382509.