Press Release             

See Also:
  • Letter to Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services
    		•
    FOR IMMEDIATE RELEASE
    Contact: Deane Beebe
    Communications Director
    212-204-6219
    E-mail
    Medicare Rights Center

    November 28, 2006

    Centers for Medicare & Medicaid Services Urged To Act Now to Avoid Chaos at the Pharmacy for Over a Million Low-Income Older and Disabled Americans in the New Year

    National Consumer Group Makes Recommendations to Ensure that Medication Treatment Regimes are Not Interrupted

    New York, NY - The Medicare Rights Center is calling on the Centers for Medicare & Medicaid Services to avert a crisis for the more than one million low-income individuals enrolled in Medicare private drug plans, who will face steep increases in prescription drug costs and abrupt changes in drug coverage when the New Year begins.

    About 288,000 low-income older and disabled Americans will be reassigned to new Medicare private drug plans beginning January 1, 2007, because their current drug plan's premium is too high to qualify for full "Extra Help," the federal subsidy which helps low-income people pay for Medicare drug coverage.

    "Last year CMS failed to heed repeated warnings about the problems expected when poor people's drug coverage is interrupted," said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service organization. "Thousands of Americans were denied their medicine and 37 state governments were forced to launch emergency rescue programs."

    "There is still time for CMS to avoid another fiasco and ensure that no one suffers the dire consequences of disrupted medication regimes again this year," said Mr. Hayes.

    The reassignment will impact people with Medicare in 40 states and will be done without regard to whether the new plan covers the drugs on an individual's medication regimen, according to a new Medicare Rights Center report "Part D 2007: Addressing Access Problems for Low-Income People with Medicare."

    Additionally, hundreds of thousands of low-income people with Medicare will be reassigned to new plans offered by the same private drug plan insurance company with no guarantees that their medicines will still be covered.

    To help ensure that low-income people with Medicare will be able to get their medications in the New Year, the Medicare Rights Center has made the following recommendations in its report:

    1. use formulary criteria to guide "intelligent" reassignment;
    2. require Part D plans to exempt from formulary restrictions any drug regimens covered under the individual's assigned plan in 2006;
    3. mandate that Part D plans carry over into 2007 all exceptions and prior authorization requests granted in 2006, whether granted by them or by another Part D plan;
    4. extend a Special Enrollment Period to all people with Extra Help, whether or not they will be reassigned to a new plan in 2007, or end the private plan lock-in instituted in 2006;
    5. guarantee that the federal government will reimburse states (and recoup costs from private insurers) when states use the Medicaid program as a fall-back option for people with Medicare and Medicaid when coverage is wrongly denied through the Part D plan.

    An additional 630,000 people eligible for Extra Help this year will be dropped from the federal subsidy program in 2007. Most of these poor older and disabled Americans still qualify for the subsidy but are no longer listed on the Medicaid enrollment files which triggers automatic enrollment in Extra Help.

    "Most older and disabled Americans won't know they lost the subsidy until they go to the pharmacy," said Mr. Hayes. "They will be required to pay full price to meet the deductible and many will leave empty handed."

    The Medicare Rights Center has urged CMS to take immediate action and require that all Part D plans implement a transitional "safety net" for individuals dropped from Extra Help, until they have been successfully reenrolled. It can take at least three to four weeks to be approved for Extra Help after an application has been submitted.

    "Part D 2007: Addressing Access Problems for Low Income People with Medicare" is available on the Medicare Rights Center's website.

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