EDITORIAL: Medicare Maze: The New Prescription Drug Program Has Been a Bewildering Mess. Will the Federal Government Learn Quickly From the Experience?
Posted on: Monday, 6 March 2006, 09:01 CST
By The Akron Beacon Journal, Ohio
Mar. 6--The new Medicare Part D benefit is barely 10 weeks old. The time has been rough going, offering lessons enough for administrators of the prescription drug program to apply the experience.
By all accounts, the rollout of the benefit program has been one of long frustration for patients, pharmacists and physicians. Last month, the Centers for Medicare and Medicaid Services, the federal agency responsible for implementing the program, proposed some changes for 2007. With the swirling chorus of complaints, the agency had little option but to seize the initiative to remove obstacles that have been obvious since the program was launched in January.
For many seniors, a profusion of drug plans (more than 100 in Ohio) intended to promote choice has induced paralyzing confusion. Enrollees face multiple options, numerous insurance companies offering varied plans, covering different drugs at different prices, charging different premium rates and working with different pharmacy networks.
In many instances, seniors who used to receive their drugs through Medicaid were switched to private drug plans that did not cover their specific medications or were referred to pharmacies that could not verify their eligibility. Delays in updating informating have led to overcharges and missed medications. As insurers modify their drug formularies, doctors, too, are scrambling with extra paperwork to help their patients keep up with proper prescriptions.
There can be too many choices, the Medicare agency appears to have wisely concluded. Among the changes under consideration for next year is limiting participating insurers to two offerings in each region, a basic and an enhanced drug plan, instead of the three permitted currently. To address bottlenecks in transmitting data, the date when coverage becomes effective would change for beneficiaries who enroll toward the end of the month.
The proposal also would require insurers whose networks include 24-hour pharmacies to provide 24-hour call lines for pharmacists as well. Further, the agency would require insurance companies to make 90-day refills on drugs, reducing the hassle to doctors and patients of repeated 30-day refills for drugs that are not covered by an insurer.
The structure of the drug benefit program, with its "doughnut hole" and multiple choices, was unnecessarily complicated. Its flaws go well beyond a mere bumpy implementation. Still, it promises many seniors significant savings -- if they can navigate the maze. The agency is proposing reasonable fixes, steps made necessary by harsh experience.
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Copyright (c) 2006, The Akron Beacon Journal, Ohio
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Source: Akron Beacon Journal (Akron, Ohio)
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