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State Bill Would Plug Prescription Benefit Hole

Posted on: Friday, 23 December 2005, 12:00 CST

By Jeffrey Krasner, Boston Globe

Dec. 23--A bill passed by the state Senate this week would protect thousands of low-income senior citizens and disabled residents from temporarily losing prescription drug benefits when their drug coverage is switched from Medicaid to Medicare Jan. 1.

The legislation is expected to win speedy approval in the House of Representatives and could become law before the end of the year. It could provide a model for other states seeking to reduce confusion and possible interruptions in drug regimens when federal prescription drug coverage goes into effect next month.

"This bill will provide a safety net for our seniors and the disabled to ensure that they continue to receive their medication regardless of whether it is covered" by the new Medicare drug benefit, said Senator Mark C. Montigny, a New Bedford Democrat, who sponsored the bill. "Seniors shouldn't suffer because of a mess created in Washington."

The legislation is now awaiting action from the House Ways and Means Committee.

"We anticipate that the full House will have an opportunity to review a committee report on Tuesday," said James Eisenberg, chief of staff at the committee. "We understand the exigency of the issue, but we need to do due diligence on it."

Eisenberg said the cost of the measure is an issue. "We've seen estimates from $8.5 million to $42 million," he said.

Kim Haberlin, spokeswoman for House Speaker Salvatore DiMasi, said the speaker supports the bill and would like it signed into law quickly.

Montigny, president of the National Legislative Association on Prescription Drug Prices, said the possible temporary loss of benefits among Medicaid beneficiaries is just one of many problems with the new drug program.

"This plan needs major changes or perhaps even a fresh start from scratch," he said.

The state measure would address one of the many complexities in the Medicare drug benefit, which is known as Part D. In addition to adding drug coverage to Medicare, the federal health program for senior citizens, it also changes drug benefits for about 6.4 million low-income seniors and disabled people. They currently receive their drugs through Medicaid, the joint state and federal program for low-income and disabled people. If those beneficiaries don't choose a Medicare drug plan, they will be automatically enrolled in one. A randomly chosen plan might not provide coverage for certain drugs, or the enrollee's regular pharmacy might not participate in the plan. That could leave some people without crucial medications.

The legislation now in the House would allocate state funds for pharmacies to provide a one-time 30-day supply of medications that aren't covered, or a three-day supply for those who need to contact a doctor to receive a new prescription.

Jeanne Finberg, director of the National Senior Citizen Law Center, which advocates for seniors on drug benefits, said the bill could become a template for other states.

"Congratulations to the state of Massachusetts for filling in the gaps the feds left out," Finberg said. "This will provide a safety net."

Finberg said the Medicare drug benefit does not offer enough protection for the disabled and so-called dual eligibles -- seniors with low incomes. For example, she said, the benefit includes small copayments for prescription drugs that could become a significant expense for low-income beneficiaries.

Locally, senior advocates say some people will likely face difficulties when the new benefit goes into effect.

"I have a definite sense there may well be problems in January, which is why I hope this bill passes," said Diane Paulson, senior attorney at the Greater Boston Legal Services' Medicare Advocacy Project. She said the Centers for Medicare and Medicaid Services, the federal agency that is overseeing the benefit's implementation nationwide, "has assured us they have all sorts of transition protections in place and people will not fall through the cracks, but if there are people who fall through, this will help them get the medication they need."

Dick Powers, a spokesman for the Executive Office of Health and Human Services, said Governor Mitt Romney will consider the legislation "if and when it gets to his desk."

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Source: The Boston Globe

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