CMS Officials Discuss Ways To Increase Low-Income Subsidy Enrollment In Medicare Drug Benefit

Main Category: Medicare / Medicaid / SCHIP
Article Date: 20 May 2008 - 5:00 PDT

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CMS officials, including acting Administrator Kerry Weems, on Friday at a hearing discussed strategies to increase enrollment in the Medicare drug benefit's low-income subsidy, CQ HealthBeat reports. The hearing between CMS and representatives of community and senior organizations focused on "targeting data points to areas of the country that could clearly benefit from" increased outreach, according to CQ HealthBeat.

CMS officials also revealed data that could be used to help locate outreach targets, including rankings by county based on estimated numbers of beneficiaries that are eligible for the low-income subsidy. According to CQ HealthBeat, such data allow outreach groups to identify counties with large numbers of beneficiaries eligible for the subsidy program and to analyze zip codes to find areas with higher concentrations of such beneficiaries. Weems said that greater outreach efforts and loosened restrictions, including allowing low-income subsidy-eligible beneficiaries to enroll in the program at any time without a late-enrollment penalty, should help boost enrollment. Weems estimated that more than 80% of those eligible for the subsidy program are currently enrolled.

Weems said he will hold regional CMS administrators accountable for enrollment by establishing and publicizing goals for regional enrollment. "We are not kidding about reaching everybody," he said.

Reasons
CMS officials at the hearing also released research on why beneficiaries who are eligible for the low-income subsidy do not enroll. The research found that many beneficiaries are intimidated by the possibility of speaking with CMS or the Social Security Administration. It also found that some are wary of sharing personal information required to enroll in the subsidy program. Some beneficiaries also did not enroll because they were in good health and did not expect to have to use prescription drugs for several more years, while others did not enroll because they were told costs were higher under the drug benefit (Reichard, CQ HealthBeat, 5/16).

Medicare Paying for Unapproved Drugs?
In related news, an Avalere Health report found that the Medicare drug benefit has been paying for medications that are not approved by FDA and that an updated Medicare formulary could restrict beneficiaries' access to certain drugs, CQ HealthBeat reports.

According to the report, CMS removed more than 1,500 drug codes from its 2008 Part D formulary, many of which were attached to drugs that were never approved by FDA or were for non-prescription drugs. The report states that only FDA-approved drugs are eligible for coverage under the Medicare drug benefit law.

According to the report, FDA is "presently unable to provide CMS, clinicians and patients a definitive list of marketed unapproved drugs," which poses a "significant challenge to CMS' mandatory review of private plans' proposed formularies."

In addition, the report said CMS' decision to drop 1,500 drug codes from its 2008 drug benefit formulary has resulted in some commercial health plans dropping many of the treatments from their Medicare plans, which could mean "significantly smaller Part D formularies in 2008 compared to 2007." According to the report, beneficiaries who were taking medications dropped from the formulary "may be forced to pay out-of-pocket for the same, now-not-covered drug, or switch to a different therapy, which could generate clinical implications."

CMS Center for Beneficiary Choices Director Abby Block said the codes were removed to increase efficiency and the move should not affect coverage. Block also said that beneficiaries could contest a drug being dropped from a plan under the insurer's medical necessity coverage exception process.

CMS officials said that Medicare drug law allows drugs in use before 1962 to be grandfathered for coverage under the drug benefit despite not officially being approved by FDA as safe and effective. Congress in 1962 passed a law that said that in order to be sold, drugs must be proven safe and effective -- not just safe (Carey, CQ HealthBeat, 5/16).

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