The transition to Medicare D(isaster) officially ended on March 31, 2006. After all of the previous mix-ups and people not being able to get their rx’s, the administration ordered the rx companies to cover a 90 day supply of prescriptions. This was supposedly done as a way to ease the transistion from Medicaid payment of prescriptions into Medicare D(isaster).
The lower cost drugs that were listed on the formularies were intended to hold the costs of Medicare D(isaster) down. However, in many instances, there is not a generic equivilant of a prescribed drug that is needed for a chronic condition. Or, in other cases, the generics or lower costing drugs that are listed on the formularies are not covered under Medicare D(isaster), unless one purchases an “enhanced” policy that will cover them. (Unfortunately the latter option is not financially possible for many who live at or below the federal poverty level.)
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According to the latest figures, roughly 27.5 million U.S. seniors are enrolled in Medicare D(isaster), with 25% individually signing up. The number of seniors using the transitional benefit to pay for drugs while switching to less expensive, and in some cases, less effective rx’s has not been disclosed by CMS.
Medicare D(isaster) allows for a five step appeal process for exceptions if a doctor can demonstrate that a drug that is not on the one of the formularies is medically necessary. And, as stated earlier, many do not know that their rx’s are not covered until they reach the pharmacy and payment for rx’s is denied. As a result of the denials, many have told the pharmacists to keep the rx’s, as they are unable to afford it.
Last Friday, a letter to President Bush stated that Medicare D(isaster) plans have not adequatley informed seniors of formulary requirements.
The letter, written by Senator Edward M. Kennedy and 9 other democrats states:
“We’re very concerned that many elderly and disabled citizens will not be able to obtain the drugs they desperately need if the transition policy ends.”
This describes exactly what happenned during the first three months of the year. However, other than repeated infomercials by the Salesman-In-Chief, little has been done to address the problems of Medicare D(isaster).
Accordng to Mark McClellan,
“Although the initial transition period is ending, the requirement for an effective transition process for all the drug plans is not. We will impose penalties when plans don’t meet the Part D standards.”
McClellan further stated that Medicare would release data on the length of call-center wait times and data relating to the length of the five step appeals process in a few weeks.
What if a Medicare D(isaster) beneficiary, such as a transplant recipient, doesn’t have a few weeks?