Pallone Questions NJ Prescription Drug Providers on Failed Implementation of New Medicare Prescription Plans

Washington, D.C. -- In light of reports that Medicare beneficiaries have been unable to access their medications since the new prescription drug benefit plan took effect on January 1, 2006, U.S. Rep. Frank Pallone, Jr. (D-NJ), today asked the 19 organizations who offer stand alone prescription drug plans in New Jersey to provide specific information on how they conducted the implementation of these plans. (A COPY OF THE LETTER PALLONE SENT TO ALL 19 INSURERS FOLLOWS).

In the letter Pallone noted that the Centers for Medicare and Medicaid Services (CMS) - whose responsibility it was to implement the new benefit - assured members of Congress and many state officials that they had taken all the necessary steps "to ensure continuity of prescription drug coverage and care for the dual eligibles." Specifically, CMS required each Medicare prescription drug plan to establish an appropriate transition process for all new enrollees, including dual eligibles.

"In spite of these assurances, it is clear that many dual eligibles still fell through the cracks," Pallone wrote. "As the primary agency responsible for implementing the new benefit, CMS should bare most of the blame for not adequately ensuring a seamless transition. However, it also appears clear that the private prescription drug plans which CMS contracted with to provide prescription drug coverage should also shoulder some of the blame."

Pallone asked the 19 organizations to provide his office with information including: a copy of their CMS-required transition policy, the number of dual-eligibles they have enrolled, the steps they took to prepare for the plan roll-out, and what steps they are taking to reimburse New Jersey for the cost it has incurred in providing emergency prescription drug coverage since January 1, 2006.

"Since January 1, 2006 there have been numerous reports that Medicare beneficiaries have been unable to access much needed medications. In many instances, beneficiaries who tried to have their prescriptions filled for the first time under the new system were told that their enrollment could not be verified, their drugs were not covered, or they would be charged larger co-payments or deductibles than they could afford," Pallone wrote. "As a result, a number of New Jersey beneficiaries - particularly those dually eligible for both Medicare and Medicaid - were faced with major disruptions in service.

Pallone said it is fortunate that many states, including New Jersey, have taken steps to ensure that Medicare beneficiaries - especially dual eligibles - are receiving the medications they were promised under the new Medicare prescription drug benefit. To date, New Jersey has spent nearly $15 million (approximately $1 million per day since the benefit began) in order to fill this unanticipated gap in coverage. The New Jersey congressman said responsibility should have never fallen upon New Jersey, or the many other states that were forced to take similar action.