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Medicare Part D Update:  President Bush Directs Drug Plans To Provide an Automatic 30-Day Supply of Medications

January 17, 2006

In order to address continuing problems with the implementation of the new Medicare drug benefit program, the Bush Administration has ordered prescription drug plans to provide a 30-day supply of any drug that a low-income beneficiary (including a dual eligible) was previously taking, for no more than $5 for each covered drug ($2 if the medication is generic). 

As part of transition rules set forth by the federal Centers for Medicare and Medicaid Services (CMS) last year, drug plans were supposed to be making this emergency 30-day transition supply available starting January 1.  However, many retail pharmacists and drug plans either did not know about this requirement, or were not complying with it.  This directive from the President should help ensure that drug plans and pharmacists begin meeting their responsibility to ensure that no dual eligible walks away from the pharmacy counter without his/her prescription being filled.

This order follows two weeks of uncertainty for some Medicare beneficiaries, particularly low-income beneficiaries who are dually eligible for both Medicare and Medicaid.  A major problem has been computer systems that verify plan enrollment, but not the individual's status as dual eligible.  As a result, many of these beneficiaries are being charged vastly more than the $1/$3 co-payment they were supposed to be charged.

As a result of these problems, as many as 20 states (including California, Illinois, Ohio, Pennsylvania and all of the New England states) have announced plans to step forward and pay for prescriptions that should have been paid by the new Medicare drug benefit since January 1.  CMS is currently pressing drug plans to meet their obligations to cover prescriptions so that financial exposure to these states is limited.

How Is the Medicare Drug Benefit Working for You?

Last week NAMI launched a toll-free hotline and e-mail response system to help individual consumers work through problems with the transition to the new Medicare drug benefit.  For more information, click here.

Click here to view the January 13 update on implementation from CMS Administrator Mark McClellan.

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