Magazine article Drug Topics

Medicare Part D Sees Flurry of Late Changes

Magazine article Drug Topics

Medicare Part D Sees Flurry of Late Changes

Article excerpt

As Medicare Part D moves into its second year, the program has undergone modest yet important changes. Still, despite sometimes significant premium increases and lack of coverage in the donut hole, most seniors seem to be sticking with the prescription drug plans (PDPs) they picked last year.

According to a recent survey from the Kaiser Family Foundation and the Harvard School of Public Health, only 5% of seniors enrolled in Medicare Part D plans expected to switch plans for 2007. "We are very concerned that we don't have the same number of people calling and looking for help with selecting a plan," explained Elana Berman, director of enrollment at the Medicare Rights Center, a patient advocacy group. "It's difficult to know what options seniors have, especially since the plans have changed significantly."

According to Berman, one of the reasons many seniors may not be actively looking to change their plans is that they did not receive "Notice of Change" letters by the Oct. 31, 2006, deadline. Recognizing the problems, CMS announced on Dec. 28, just days before the deadline, that it would extend the deadline to Feb. 14 for some 250,000 beneficiaries of United Healthcare and other PDPs who received the letter after Nov. 15, 2006, or not at all.

"As part of the CMS commitment to have beneficiaries compare plans, CMS is taking immediate action to ensure that beneficiaries who did not receive timely information from their current drug plan will be given additional time to compare their 2006 and 2007 coverage and cost details and change plans if they choose," explained CMS spokesman Jeff Nelligan. These beneficiaries will be allowed to continue with their current plans, including the current formularies, deductibles, and monthly premiums, until the extended deadline.

Beginning in 2007, a number of pharmaceutical companies will begin to offer patient assistance programs (PAPs) designed to help Part D beneficiaries in the donut hole. PAP plans are offered by drug companies to low-income recipients using specific brand medications. In many cases, the drug company offers its brand medication at little or no cost to recipients. Still, beneficiaries must meet strict guidelines for eligibility and must apply to individual PAPs for each drug separately.

GlaxoSmithKline developed the GSK Access PAP plan that is open to low-income beneficiaries who have spent at least $600 in true-out-of-pocket (TrOOP) expenses. …

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