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A Real Choice
December 7, 2006 • Volume 6, Issue 48Rather than giving people with Medicare the choice they really want—drug coverage through the Medicare program they trust—the Congressional leadership now shuffling toward the exit door gave the American people Part D. Under Part D, people with Medicare can get coverage for their medicines only by choosing from an array of private drug plans sponsored by insurance companies.
But how to pick the right one?
Finding a plan that covers your drugs is a crucial step as is looking for one with an affordable monthly premium. But there are other important questions to ask. For example:
Does customer service pick up the phone when you call?
If you need a medicine the plan does not normally cover, does the plan make an exception based on medical necessity?
Will the plan jack up prices on its drugs after you enroll and are you locked in for the remainder of the year?
To help answer these and other questions, the Centers for Medicare & Medicaid Services (CMS) has compiled performance data on the Part D plans and posted it on its plan comparison web site, www.medicare.gov. But the rating system used by CMS says more about the Bush administration’s desire to make Part D look good than it does about the actual performance of the Part D private drug plans.
On the crucial question of whether the plan grants exceptions to its coverage restrictions based on medical necessity, plans can get a three star rating—the highest available—when their medical judgments are overturned half the time. Even plans overruled through an independent review on well over 50 percent of their appeals get one star. There seems to be no level of performance bad enough to warrant zero stars, or, better yet, a warning sign. Whose side in CMS on?
This grade inflation carries over into ratings on the performance of plans’ call centers. According to a survey by Consumers Union, publisher of Consumer Reports, every single plan received three stars for customer service and pharmacy support wait times. CMS handed out three stars to any plans with average wait times of under five minutes, even though the actual plan averages (for pharmacists) ranged from 24 seconds to two-and-a-half minutes. That doesn’t sound like much, but a high average may indicate the plan had many extraordinarily long wait times. People with Medicare reported being on hold for an hour or more last January, but it’s impossible to tell which plans are providing such terrible customer service from CMS’ ratings.
Finally, a comparison of Part D plans in Northern Virginia shows that plans could raise prices on over 20 percent of their drugs and still receive a three star rating, a performance CMS considers “very good.” The real story is much worse. Families USA found that over 85 percent of the Part D plans raised prices on 15 of the top 20 drugs taken by older adults over the early months of the Part D drug benefit.
The reason for the price increases is clear. Compared to Medicare’s ability to force lower drug prices, the private Part D plans are failing. Rather than pushing these private plans on consumers, and making plan selection more difficult with a meaningless rating system, the Bush administration and the new Congress should provide people with Medicare a real choice—a Medicare drug benefit.
Medical Record
“Last year, after reviewing many Part D plans, I went with Humana Complete because it covered drugs in the ‘doughnut hole.’ My monthly premium is $63 a month. My 11 prescriptions cost me $200 a month. However, I just received my ‘Annual Notification of Change’ from Humana: my premium will go up to $85 a month next year, and I will have to pay the full cost of my nongeneric prescriptions in the doughnut hole! I receive Social Security Disability Insurance and I work a part-time job with limited hours. I cannot make any more money” (Story submitted to the Part D Monitoring Project, Medicare Rights Center, November 30, 2006).
“As the data shows, overall most plans received three stars most of the time. While Mr. Garrison Keillor’s line, ‘that in Lake Woebegon (sic) all the children are above average,’ always gets a smile, not all Medicare plans are above average. It is essential where there are so many choices for beneficiaries to pick among, that tougher quality standards be set. Only if the quality criteria are drawn tighter will consumers be able to see which plans are really worth rewarding” (Letter to Leslie V. Norwalk, CMS Acting Administrator, Consumers Union, December 4, 2006).
“Price trends show that the Part D plans are not exerting downward price pressure on drug manufacturers. In fact, since the start of program enrollment, prices for the Part D plans have increased much more frequently than they have decreased or remained constant. What’s more, Part D plans appear to be simply passing manufacturer price increases along to Medicare consumers. In addition, Part D plan prices are significantly higher than the prices available through the VA [Department of Veterans Affairs]: For each of the 20 drugs most frequently prescribed to seniors, the lowest price available through any Part D plan was higher than the lowest price negotiated by the VA. This performance hardly demonstrates the strong negotiating leverage the Administration claimed the private plans would exert” (“Big Dollars, Little Sense: Rising Medicare Prescription Drug Prices,” Families USA, June 2006).
***** 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.
Fast Relief: Part D Monitoring Project
Submit your story at www.medicarerights.org/partdstories.html
*****
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 e-newsletter 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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