Increasing Low-Income Subsidy Enrollment In Medicare Drug Benefit

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

CMS officials also revealed data that could be used to help locate outreachtargets, including rankings by county based on estimated numbers ofbeneficiaries that are eligible for the low-income subsidy. According to CQHealthBeat, such data allow outreach groups to identify counties withlarge numbers of beneficiaries eligible for the subsidy program and to analyzezip codes to find areas with higher concentrations of such beneficiaries. Weemssaid that greater outreach efforts and loosened restrictions, includingallowing low-income subsidy-eligible beneficiaries to enroll in the program atany time without a late-enrollment penalty, should help boost enrollment. Weemsestimated that more than 80% of those eligible for the subsidy program arecurrently enrolled.

Weems said he will hold regional CMS administrators accountable for enrollmentby establishing and publicizing goals for regional enrollment. "We are notkidding about reaching everybody," he said.


CMS officials at thehearing also released research on why beneficiaries who are eligible for thelow-income subsidy do not enroll. The research found that many beneficiariesare intimidated by the possibility of speaking with CMS or the Social SecurityAdministration. It also found that some are wary of sharing personalinformation required to enroll in the subsidy program. Some beneficiaries alsodid not enroll because they were in good health and did not expect to have touse prescription drugs for several more years, while others did not enrollbecause they were told costs were higher under the drug benefit (Reichard, CQHealthBeat, 5/16).


Medicare Paying forUnapproved Drugs?

In related news, an Avalere Health report found that the Medicare drug benefithas been paying for medications that are not approved by FDA and thatan updated Medicare formulary could restrict beneficiaries' access to certaindrugs, CQ HealthBeat reports.

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

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 privateplans' proposed formularies."

In addition, the report said CMS' decision to drop 1,500 drug codes from its2008 drug benefit formulary has resulted in some commercial health plansdropping 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 fromthe formulary "may be forced to pay out-of-pocket for the same,now-not-covered drug, or switch to a different therapy, which could generateclinical 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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