Kaiser Daily Health Policy Report
Thursday, December 01, 2005
Another Medicare “Mess?”
GAO Report Finds Problems With
Medicare Prescription Drug Discount Program; Some Say Findings Indicate Trouble
for Medicare Drug Benefit
There were "serious, widespread problems" in the Medicare
prescription drug discount card program launched last year, including
"inaccurate and incomplete information ... and improper use of the
discount cards" to purchase drugs not covered under the program, a Government Accountability
Office report released in October says, the New York Times reports. The drug discount card
program, intended to provide temporary drug coverage to Medicare beneficiaries
until the Medicare drug benefit begins
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Information about the cards that CMS posted
online often was inaccurate, and many pharmacies listed as participating in the
program did not.
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Insurers and pharmacy benefit managers often violated
federal rules by disseminating "incomplete, inaccurate information about
their own Medicare-approved discount cards," the Times reports.
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Sponsors of 15 cards subjected to financial audits
improperly used Medicare funding to pay for barbiturates and other medications
they were not allowed to cover. Total incorrect payments reached $1.3 million.
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Sponsors of five drug cards allowed beneficiaries to
obtain subsidies that were higher than the maximum of $600 per year.
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Operators of a telephone help line demonstrated
"confusion about the enrollment fees" charged by different cards,
according to the report (Pear, New
York Times, 12/1).
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CMS provided inadequate guidance to drug card sponsors
because of the six-month time constraint in which the program was implemented,
and although the agency addressed some of the problems, the overall quality of
guidance "remained questionable" as of August 2005, the report says.
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Some beneficiaries complained of delays in receiving drug
cards.
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CMS took 23 actions for noncompliance against 15 drug card
sponsors in warning letters or corrective action plans.
Second Report
A second GAO report issued Nov. 18 says that CMS effectively
raised awareness among the public about the drug card program but failed to
provide "clear, accurate and accessible" information to educate
beneficiaries, CQ HealthBeat
reports. The report also finds that beneficiaries were confused about the new
drug cards, which might have resulted in lower-than-expected enrollment, and
did not have clear access to information about their options. CMS also faced
challenges in addressing the needs of low-income beneficiaries and those who
did not speak English, the report says, according to CQ HealthBeat.
Reaction
Rep. Henry Waxman (D-Calif.), who
requested the GAO research, said the reports indicate "serious flaws"
in the implementation of the drug card program. In a letter to CMS
Administrator Mark McClellan, Waxman said the errors "have important
implications for the new Medicare drug benefit" (CQ HealthBeat, 11/30). "Continued
lax oversight and enforcement will serve neither seniors nor the
taxpayers," Waxman said, adding that there are "fundamental
similarities" between the drug card program and the full drug benefit.
Like the drug card program, the full benefit "requires seniors to choose a
private plan from among dozens of choices, relies on
private entities to negotiate drug savings and uses a complicated Web site to help
seniors make their choices," he said. According to the Times, McClellan defended the drug
card program and said it had produced significant savings for beneficiaries. He
said, "[W]e have learned many valuable
lessons" that CMS will apply to the new drug benefit. McClellan also said
CMS will try to recover the funding that was improperly spent on drugs not
approved under the program but noted that the "inappropriate payments
represent only a tiny fraction" of total spending under the program (New York Times, 12/1). McClellan also
noted that the November report "did not create the full picture of the
depth and breadth of the actual activities undertaken" by CMS to educate
beneficiaries about the drug card program (CQ HealthBeat, 11/30). (From: KaiserNetwork.org,
12/01/05)
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