Medicare Compliance & Reimbursement

One organization offers tips on how your patients can save on drugs. Approximately 48 percent of all Medicare Part D beneficiaries will be left without drug coverage this year when they reach the infamous "doughnut hole" in their prescription drug plans, according to a new study.

Only 4 percent of the 22.5 million Part D benes are in plans with doughnut-hole coverage for both generic and brand-name prescription drugs, Kaiser Family Foundation's principal policy analyst Juliette Cubanski and vice president Patricia Neuman said in their report. The Kaiser report appeared on the Health Affairs Web site shortly after the Nov. 15 commencement of the Part D Open Enrollment Period, which will last until Dec. 31.

"Another 8 percent of enrollees have coverage in the doughnut hole for generics only," according to the Nov. 21 Health Affairs release. Subtracting the low-income benes who have subsidized gap coverage leaves nearly half of all Part D enrollees without doughnut-hole coverage. Enrollment Choices May Be More Difficult For Seniors To Make This Time Around With so many seniors left without gap coverage this year, the question is whether benes will have the know-how to pick the right plan (preferably one with adequate doughnut-hole coverage) for 2007.

The federal government believes that seniors will have the help they need during the open enrollment to choose appropriate plans, but industry leaders and researchers are skeptical.

"Building on last year's successes and experiences, beneficiaries and those who are assisting them have access to a variety of consumer tested tools and resources which have been enhanced to help them make confident, well-informed decisions about their health and prescription coverage in 2007," the Centers for Medicare & Medicaid Services' (CMS) acting administrator Leslie V. Norwalk said in a recent statement.

MS is touting its new online tools that it put in place to help enrollees choose the right Part D plan for them, including information on Part D plan performance, which the agency posted on its Plan Finder Web site. Benes can "see how plans are rated along with specific data on how they performed on the following areas of customer service, including: telephone customer service, complaints, appeals and sharing information with pharmacists," CMS explains.

But benes may still have a hard time choosing a prescription drug plan (PDP), simply because there will be 31 percent more stand-alone PDPs available in 2007 than in 2006, and those that offer full gap coverage are still few, the Kaiser report authors note. Indeed, more PDPs will offer gap coverage in 2007 than this year, but most are offering generic-only coverage.
 
For instance, "Humana PDP Complete, which had the highest enrollment among plans offering full gap coverage in 2006, will cover only generics in the gap in 2007," [...]