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Ring Ring!
July 6, 2006 • Volume 6, Issue 27

One of the most common complaints from people with Medicare during the chaotic first six months of the Part D drug benefit was the abysmal customer service provided by the Part D plans. People could not get through to the plans’ 800 numbers. When they did get through, they were put on hold, often for more than one hour. After they were put on hold, they were disconnected.

When customer service did pick up, very often they could not provide a useful answer:

The list goes on. The Bush administration downplayed the problems because it was determined that Part D appear to be a success, whether it was or not. If people with Medicare cannot get the most basic kinds of consumer information, then a model based on competition and “choice” makes no sense. If Part D plans can’t deliver, then Medicare should deliver the drug benefit. A simple, standard and comprehensive Medicare drug benefit would make most of the frantic calls to customer service unnecessary, and eliminate the nearly impossible task of overseeing the performance of more than 80 companies offering Part D plans.

The administration’s PR effort largely failed, because this time, reality overwhelmed spin. But that has not stopped the spinmeisters. Last week, the Centers for Medicare & Medicaid Services (CMS) released the first data comparing the Part D plans’ customer service. Despite repeated requests, however, CMS did not release information showing whether the Part D plans are meeting the minimum customer service requirements established by the agency. Instead, CMS set up a new test designed so that all plans would pass, and . . . they all did.

CMS asked the plans, whether, on average, they answer their customer service lines and their direct lines for pharmacists within five minutes. Not surprisingly, except for a couple of bad actors who refused to answer, they all said “Yes.”

Ring Ring!

Now, 5 minutes is a long time to wait for someone to pick up the telephone, especially if you are a pharmacist with a line of customers at the counter. An average of five minutes to answer a call tells you next to nothing about the plan. How many calls were answered promptly? How many had wait times in excess of 30 minutes? How many calls were dropped? And finally, how many calls were answered correctly?

Instead of setting up this bogus test, CMS should hold plans to account on the customer service requirements it has already laid out: Part D plans must answer 80 percent of calls within 30 seconds, not five minutes, and cannot drop more than 5 percent of all calls. Call centers are also required to provide thorough information on benefit coverage, respond to inquiries and handle customer complaints, and explain in detail how to appeal for coverage. When will consumers find out how the Part D plans measure up according to these standards? When will CMS release information on how the plans handle grievances and appeals and on how often plan members run into barriers to access, like prior authorization requirements?

We’re waiting.

Write CMS Administrator Mark McClellan asking that consumer information be made available.

Medical Record

“The pharmacist told me according to the computer I needed prior authorization from the doctor. I called the phone number that was give for prior authorization for three days. Each time I had one of three responses. One was a computer message that said ‘due to an unusually high volume of calls we are unable to take the call, please try again later’ and hung up. The other was a computer message that said ‘please hold for the next available representative’ and then hung up. The last was being put on hold for up to two hours and fifteen minutes just to be told that I would be transferred to the ‘exceptions department’ where I could request a waiver. This waiver would need my doctor's reasons for prescribing the drug along with a two- to three-day wait for a decision. If the result was that my drug was denied, I could then appeal the decision. When the call was finally transferred, I got the message ‘due to an unusual number of calls’ and then the phone hung up” (From “Chaos at the Pharmacy," Medicare Rights Center Part D Monitoring Project, January 13, 2006).

“We urge the Subcommittee and Congress to request that in addition to call center performance data, that CMS make information public as soon as possible on:

“In the past month, CMS has received approximately 2.2 complaints per 1,000 Medicare beneficiaries enrolled in prescription drug plans. The complaint rate for stand-alone prescription drug plans has averaged about 2.5 per 1,000 beneficiaries, and the complaint rate for Medicare Advantage prescription drug plans has averaged about 1.6 per 1,000 beneficiaries. Most of these involve complaints about enrollment or disenrollment in a plan (the most common type in recent months), complaints about difficulty in getting needed drugs, and complaints about the cost of the drugs or incorrect co-pays at the pharmacy counter” (“Medicare Details Steps Taken to Improve Customer Service by Drug Plans,” CMS, June 29, 2006).

Fast Relief: Part D Monitoring Project

The Medicare Rights Center (MRC) needs to hear about all the problems with the Medicare Part D benefit, whether they happen to you or someone in your community. With this information, we will be armed with the needed evidence to push for a Medicare-administered drug benefit.

Submit your story at www.medicarerights.org/partdstories.html

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The Louder Our Voice, the Stronger Our Message

Asclepios — named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly action alert designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.

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