MedPAC Discusses Strategies To Reduce Barriers To Care In Medicare

Main Category: Medicare / Medicaid / SCHIP
Article Date: 12 Nov 2007 - 8:00 PDT

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The Medicare Payment Advisory Commission on Thursday debated a package of recommendations that are designed to reduce barriers to care for low-income beneficiaries, CQ HealthBeat reports. The three recommendations are as follows:

• The HHS secretary would be required to increase funding for the State Health Insurance Assistance Program. SHIP helps enroll beneficiaries in Medicare Savings Programs -- which reduce costs for low-income beneficiaries -- and also in the Medicare drug benefit's low-income and disabled program.
  
  
• The application process for MSPs would be simplified by changing income and asset limits to be consistent with the drug benefit's low-income program.
  
  
• Congress would enact changes to enable the Social Security Administration to screen applicants for the drug benefit's low-income program to determine whether they are eligible for MSPs and to enroll them if applicable.

The recommendations were made to help Medicare beneficiaries who sometimes forgo care because they cannot afford copayments or other out-of-pocket costs. MSPs lower those costs, but only a small percentage of eligible beneficiaries are enrolled in the program.

Analysts say that enrollment is low because of low awareness, complex application processes and reluctance to go to Medicaid offices because of perceived stigma. MedPAC supported all three recommendations but said that having SSA screen applicants for the drug benefit's low-income program to determine MSP eligibility would increase state spending because MSPs are funded through Medicaid. The commission will vote on the recommendations in December (Reichard [1], CQ HealthBeat, 11/8).

Drug Plan Costs Outlined
Also on Thursday, MedPAC reviewed data on Medicare Part D, presented by Georgetown University researcher Jack Hoadley. The drug benefit is administered through stand-alone Prescription Drug Plans or Medicare Advantage plans, which use different levels of copays or restrictions to control costs. The percentage of PDPs using three-tier systems -- which charge different amounts for generic, preferred brand-name and brand-name drugs -- is increasing. In 2007, 69% of PDPs used the three-tier system, up from 61% in 2006.

MA plans using three-tier systems rose from 67% in 2006 to 80% in 2007. In addition, 80% of both types of plans used a "specialty" drugs category, which applies to treatments with unusually large monthly costs, under which they pay for 25% to 30% of the cost. In addition copays, 18% of drugs in formularies for both plans had restrictions, such as prior authorization, which requires a physician to get permission to prescribe the drug, or step therapy, which requires beneficiaries to use cheaper drugs first before moving on to more expensive treatments (Reichard [2], CQ HealthBeat, 11/8).

Medicare Physician Reimbursement Cut
In other Medicare news, physicians on Thursday told the House Small Business Subcommittee on Regulations, Health Care and Trade that the scheduled 10% Medicare physician fee cut would place serious financial hardship on individuals or small group practices, CQ HealthBeat reports. Witnesses testified that expenses have increased faster than Medicare reimbursement rates, which makes it harder for physicians to take new Medicare patients or maintain the beneficiaries they currently serve.

Subcommittee Chair Charlie Gonzales (D-Texas) said, "Medicare reimbursement cuts are a barrier to the successful operation of solo and small group practice[s]," adding, "For many small practices, Medicare is the single most important source of revenue, and it often [is] used to extend or supplement charitable care to the uninsured and underinsured. Cutting Medicare's low reimbursement rates would result in many practitioners denying or limiting access to charitable care" (Carey, CQ HealthBeat, 11/8).

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