CMS reports improvements in Medicare Part D

April 17, 2006

Things are looking up in relation to Medicare Part D, according to Mark McClellan, head of the Centers for Medicare & Medicaid Services. In early March, he addressed an audience of 700 pharmacists from New England on the status of the drug benefit, as the program passed its 60th day in operation. The presentation was the keynote address at the 66th Howard L. Reed Conference, sponsored by the Massachusetts College of Pharmacy and Health Sciences.

McClellan referred to the first 60 days as a time of significant change in pharmacy service, calling pharmacists the "linchpin" of the new benefit. "Your outreach efforts to beneficiaries have been tremendous," he said. He noted the program had improved since its inception, with a decline over the past two months in the number of case work requests related to dual eligibles and low-income subsidy eligibility enrollment. He explained that CMS has made efforts to beef up the number of available reps at plan call centers in an effort to decrease pharmacist wait times and has also implemented the E1 transaction, which works with existing pharmacy computer systems to give R.Ph.s access to real-time enrollment and eligibility information.

There's also been a steady downward trend in reports of problems. About 95% of beneficiaries who sign up for coverage and are able to wait a few weeks before using their benefit-allowing time for the data to be fully loaded into the plan billing system-will have a smooth experience when they first show up at the drugstore, according to McClellan.

"An analysis of drug coverage released last week by CMS showed that beneficiaries enrolling in low-cost plans can save 60% on average on their drug costs," McClellan said. And a savings of 70% or more is possible by buying generic or therapeutic alternative drugs instead of their brand counterparts. He reminded attendees that pharmacists can request personalized reports of their patient's projected savings by switching to lower-cost alternatives by calling 1-(800) MEDICARE.

McClellan acknowledged the fact that the combination of Medicare Part D and the Deficit Reduction Act recently passed by Congress has left many pharmacists struggling financially. "It's not business as usual for pharmacists, particularly for independents," he said. A few attendees in the audience couldn't have agreed more. One pharmacist spoke up and compared the implementation of Medicare Part D to the federal government's handling of Hurricane Katrina. "It wasn't done quite right," he said. He described how he'd received payment for scripts filled in early January some 12 to 14 weeks later. "I'd like to participate in your drug program in a positive way," he told McClellan, "But I just can't run a business this way."

A second R.Ph, an independent owner from Maine, had also experienced delayed payments. For his 1,000 customers participating in the Medicare program, he was owed more than $100,000, and had only just received his first payment days earlier. "Not many can stay afloat this way. I have to evaluate which plans I can afford to stay in," he said.

McClellan promised to investigate any and all pharmacist complaints and pointed out that the plans are required to meet contractual obligations. He suggested that these pharmacists contact CMS so it could investigate the delayed payments.

In closing, McClellan said CMS is trying to shift the focus from simply paying less for the services that are being delivered to paying more for greater value in health care. He hopes this will happen through effective medication management programs.