One-day Turnaround Promised for Low-income Seniors to Access Part D-July 2008

The Bush administration has agreed to make significant changes in how it runs the Medicare Part D prescription drug program, on the heels of a lawsuit filed on behalf of 6.2 million low-income beneficiaries who have faced chronic problems obtaining their prescription medications.

The case was filed by the National Senior Citizens Law Center (NSCLC) and the Center for Medicare Advocacy. The plaintiffs argued that the Bush administration, in developing Part D enrollment policy, failed to provide sufficient protections for low-income senior citizens and persons with disabilities—those dual-eligible Medicare beneficiaries who also receive Medicaid.

Among the problems: the information management system that notifies pharmacies of the enrollment and low-income status of dual eligibles has been plagued by extensive delays. The system also is extremely complex, creating ongoing barriers for this population to obtain needed medication; dual eligibles rely on an average of 10 more prescriptions per month than other Medicare beneficiaries.

In exchange for the plaintiffs’ dismissal of their claims against the government, the Centers for Medicare & Medicaid Services (CMS) agreed to make a number of changes to streamline the enrollment process, including a pledge to process new enrollment paperwork for dual eligibles in 1 business day (instead of the several weeks they have to wait currently).

Drug plans and CMS regional offices also must provide additional assistance to beneficiaries whose names are inadvertently missing from pharmacy or plan computer systems. New protocols will shift the burden of proof away from beneficiaries and to providers when eligibility is in question. CMS also will educate pharmacy organizations about the new protections.

“This settlement agreement is a victory for many of our nation’s most vulnerable citizens,” said NSCLC staff attorney Kevin Prindiville. “These individuals have faced life-threatening delays in receiving vital medication. They do not have the means to front the costs of their prescription drugs while Medicare and the plans sort out the paperwork. We view the administration’s agreement to this settlement as a sign that it is now committed to providing adequate protection for these beneficiaries.”