Insurers' Prescription Drug Market Plans Don't Meet Medicare Guidelines

Ruzanna Harutyunyan's picture

Nearly 85% of the marketing materials used by private prescription drug plans to reach Medicare beneficiaries do not fully meet CMS guidelines, according to a report released Thursday by the HHS Office of Inspector General, CQ HealthBeat reports. The report found that CMS provided the drug providers with faulty sample documents on which they were to base their marketing materials. The sample documents omitted information on the low-income subsidy program and some information about how the enrollment process works.

In addition, the report found that 79% of marketing materials for plans associated with specific pharmacy companies did not tell consumers that they could continue to get their medications from other pharmacies, and 42% did not inform consumers about how they could get their prescriptions filled if the usual mail order option was unavailable. According to CQ HealthBeat, some of the errors in the marketing materials were "relatively minor," including the wrong size font in footnotes (Armstrong, CQ HealthBeat, 9/4). The report found that some marketing materials failed to provide an alphabetical index of the drugs a plan covered (Freking, AP/San Francisco Chronicle, 9/5). The report also found a year-and-a-half delay by CMS to review many of the materials given to consumers in 2006 (CQ HealthBeat, 9/4).


Medicare officials said that many of the issues cited in the report "are not atypical during the initial start-up of a new program" (AP/San Francisco Chronicle, 9/5). CMS spokesperson Jeff Nelligan said, "CMS has generally already implemented the [OIG] recommendations," adding, "Oversight and review is focused on the requirements that are most critical to beneficiary understanding." The report found that CMS has since corrected the sample documents and has finished the review of many delayed marketing materials (CQ HealthBeat, 9/4).

Senate Finance Committee Chair Max Baucus (D-Mont.) said, "It's unconscionable that CMS has let the insurance industry's materials, including essential items like pharmacy directories and summaries of benefits, fail to properly inform seniors 85% of the time" (AP/San Francisco Chronicle, 9/5). He added, "This report reveals a near-total failure by CMS, where officials have insisted that they can regulate the marketing of plans to seniors as well as or better than experienced state insurance agencies," but the "evidence now shows that's not the case." Baucus in a statement said, "You'd better believe the Finance Committee will move to make sure seniors get better services one way or the other" (CQ HealthBeat, 9/4).

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