Arkansas Delegation Calls on CMS to Fix Operational Problems of new Medicare Benefit Washington, DC – After receiving numerous complaints from pharmacists and Medicare beneficiaries throughout Arkansas, Senators Blanche Lincoln, and Mark Pryor, along with U.S. Representatives Marion Berry (AR-01), Vic Snyder (AR-02), Mike Ross (AR-04), and John Boozman (AR-03), sent a letter to Mark McClellan, Administrator of the Centers for Medicare and Medicaid Services (CMS), requesting his immediate attention to a number of operational problems with the new Medicare Part D prescription drug benefit. These setbacks make it difficult for pharmacies to provide continuous drug coverage and prevent many patients from receiving necessary prescriptions. The operational problems began on January 1, 2006, when pharmacists tried to use the CMS database to deliver prescriptions to Medicare recipients. Pharmacists struggled to find patient information in the overwhelmed and incomplete database, which is lacking information on some individuals eligible for both Medicare and Medicaid, and does not recognize low-income subsidy patients. As pharmacists are unable to locate a patient's plan, they are either turning people away or providing prescription drugs at no charge. Some Prescription Drug Plans (PDPs) are adding to the confusion by refusing to fill prescriptions for dual eligible enrollees whose drugs are not covered under plan formularies. This is a direct violation of the CMS regulations which require private plans to provide continuous drug coverage during this transition. The Arkansas Delegation is also calling on CMS to clarify language that may conflict with Arkansas state law by allowing Long Term Care facilities to contract with a single Long Term Care pharmacy on behalf of all its residents. However, Arkansas state law protects a nursing home patient's right to choose their own pharmacy. A copy of the letter is provided below. January 9, 2006
Dear Dr. McClellan, We are writing on behalf of our constituents to express our concern with the implementation of the Medicare Part D prescription drug benefit. We believe that the Centers for Medicare and Medicaid Services (CMS) should immediately address serious operational problems which are leaving many Medicare beneficiaries without necessary prescriptions. Those most severely affected are the dual eligible population, people with both Medicare and Medicaid. We are concerned that the safety net created by CMS to ensure all dual eligibles were able to receive their medications has fallen short. Specifically:
In addition, we request that CMS immediately address a problem unique to our constituents in Arkansas. A Long Term Care (LTC) guidance document issued by CMS on March 16th, 2005, states, "We expect that each LTC facility will select one or possibly more than one eligible NLTCP to provide Medicare drug benefits to its residents. A facility can continue to contract exclusively if it chooses, however, the features to promote competition . . . will likely give each facility access to a broader range of potential LTC pharmacies than is the case today." We believe this guidance to be inadequate and ask CMS to promptly clarify the intent on a patient's right to choose a pharmacy when such a right exists under state law. We thank you for your attention to these matters and look forward to your prompt response. Sincerely, _______________________________ -30- | ||||||||
