The early chaos of the new Medicare Part D prescription drug program diminished in recent weeks. The government reports that the program is saving money. Part D, however, faces a number of new hurdles that have many senior advocates, including TSCL, asking Congress to step in.

Recently a 90-day grace period ended for drug plan enrollees. For the first 90 days of this year, Medicare required drug plans to cover medications of their enrollees even if the medicines weren’t normally covered by their plan. The Centers for Medicare and Medicaid Services (CMS) said the 90-day period was designed to give beneficiaries and their doctors time to either try different prescriptions that were covered by their drug plan, or file appeals for medically-necessary drugs.

Benjamin Brewer, M.D., who writes a column for The Wall Street Journal, complained that the Medicare drug benefit is bogging down the offices of doctors with the sheer volume of these requests. "It’s eating up hundreds of hours of nursing time per month that we don’t receive compensation for," he said, adding that some physicians are trying to push this added administrative burden back on to the patients who are often ill- equipped to handle it.

Large numbers of new enrollees in drug plans may be learning soon that they’re about to fall into the Medicare Part D "doughnut hole." Medicare recently started sending out letters telling some drug plan enrollees how close they are to the doughnut hole or gap in coverage. Unless enrolled in a plan that offers coverage for this gap, beneficiaries must spend a total of $3,600 in drug costs out-of-pocket before their Part D plans kick back in and cover 95% of the costs after that. (To read more about this see the "Social Security & Medicare Questions.")

Medicare also began the process of notifying well over a million Medicare beneficiaries who are listed on the rolls of two drug plans. Those beneficiaries will be dropped from one drug plan, and will retain coverage under the other plan. Last year, the federal government automatically assigned low-income beneficiaries to new drug plans regardless of whether the plans covered their necessary prescriptions or not. Hundreds of thousands of seniors and the disabled found it necessary to switch to a more appropriate plan. But due to a glitch in the disenrollment notification process, low income beneficiaries ended up enrolled in two plans at once. Beneficiaries could be charged two premiums and may be billed improperly for costs.

TSCL believes that many of Part D’s widespread and persistent problems will be extremely difficult, if not impossible to solve administratively, and believes that Congress must act to simplify the benefit. Seniors who responded to TSCL’s 2006 Advisor Senior Survey overwhelmingly agree. Some 92% of those responding to the survey also say the government should be allowed to set drug prices for Medicare like it does for Veterans TRICARE drug benefit.

Have you signed TSCL's Medicare Prescription Drug Plan Protest Petition?

Sources: "Safeguard Expires For Uncovered Prescritions in New Medicare Drug Plan," Ricardo Alonso-Zaldivar, The Los Angeles Times, April 1, 2006. "Medicare Drug Plans Create More Work," Benjamin Brewer, M.D., The Wall Street Journal, April 4, 2006. "Retirees On 2 Drug Plans Must Make Choice," Robert Pear, The New York Times, March 28, 2006.

May 2006