Improve Comparison Of Medicare Prescription Drug Plans

Rep. Stark Proposes Changes To Improve Comparison Of Medicare Prescription Drug Plans

House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) at a hearing on Thursday said that he might push for measures this summer that would increase oversight of Medicare prescription drug plans, CQ HealthBeat reports. Provisions of the measure could include giving state insurance regulators the authority to oversee insurers that market the plans and requiring public disclosure of enforcement action taken against drug plans that violate Medicare regulations. The proposal also could include a provision that would mandate coverage of benzodiazepines, which are used to tranquilize nursing home patients, among other uses.

The measure also might require the same open enrollment periods for stand-alone Medicare prescription drug plans and plans sold under the Medicare Advantage program. In addition, legislation could include a provision that would require Medicare drug plans to cover six therapeutic drug categories.

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Stark at the hearing said, “I hope this … will lay the groundwork for improvements to Part D that may be included in the Medicare sections of forthcoming health legislation we hope to move this summer,” which also would reduce Medicare payments to some providers to fund children’s health care.

Stark said his goal is to make it easier to compare Medicare prescription drug plans, but “he didn’t specify whether he will seek to do so in the legislation,” CQ HealthBeat reports. He added, “I hope we can at least talk about standardizing Part D products so beneficiaries are better able to compare the 50 or more plans available in their communities” (Reichard, CQ HealthBeat, 6/21). Stark said, “In a perfect world, today’s hearing would focus on creating a Part D plan run by Medicare that would negotiate for lower prices that compete against the private plans.” However, he said, “I know that proposal isn’t yet ripe.”

Ranking subcommittee member Dave Camp (R-Mich.) said, “Is Part D perfect? Of course not. Can Part D be improved? Absolutely. But we need to tread carefully when considering fundamental changes to this important, successful and well-liked program” (Kreisher, CongressDaily, 6/22).

Testimony

Witnesses at the hearing detailed a number of possible improvements to the prescription drug program, including expanded access to HIV/AIDS medication, ensuring accurate premium deductions from Social Security checks and reducing enrollment delays for beneficiaries who are dually eligible for Medicare and Medicaid.

Kathleen King, health care director at the Government Accountability Office, said it takes up to five weeks to complete the enrollment of dual-eligible Medicare beneficiaries. King said that the enrollment delay sometimes makes it difficult for dual eligibles to get prescriptions filled during that time. King estimated that the problem has affected about 400,000 beneficiaries this year.

In addition, acting CMS Director Leslie Norwalk said that Congress must ensure accurate premium deductions from Social Security checks. However, she added that there is no “quick fix” to the problem.

Paul Precht, director of the Medicare Rights Center, testified that some beneficiaries are having trouble enrolling in plans, getting access to affordable medications and obtaining coverage for medications once they are enrolled in a drug plan (CQ HealthBeat, 6/21).

GAO testimony from the hearing is available online. Note: You must have Adobe Acrobat Reader to view the report.

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