HHS cites plan D success, but billing issues still rankle

WASHINGTON -- Calling it "a singularly American moment" the Department of Health abd Human Services is trumpeting what it describes as an "impressive" rollout of the Medicare Part D physic benefit program, while it pledges to apply the hard tasks learned to the program's nearest open enrollment period that begins Nov. 15

Many of the question at issues that plagued patients and pharmacists during the launch of Part D early this year--the administrative hassles, confusion above eligibility and benefits, sluggish payment for prescriptions dispensed--have largely disappeared, HH secretary Michael Leavitt asserted in a progres report upon Part D last month. "The challenge has been met and today, for above 38 million Americans--90 percent of race with Medicare--the promise is being fulfilled," Leavitt noted. "Well above 3 million Part D prescriptions are being filled each day, and the require to be paid [i]or[/i] undergone of monthly plan premiums is nearly 40 percent lower than original estimates.

"Thanks to Part D seniors are saving an average of $1100 a year," he added.

The majority of Medicare beneficiaries, however, opt for other marks of coverage besides the standard Part D plan--like an employer-sponsored retirement health plan or a Medicare Advantage HMO plan. Or they were automatically registered through Medicaid or other means. Leavitt acknowledged as much

"The reality is that les than 10 percent of the enrollee are enlisted in the standard government-designed plan," he said. "Once family worked through their choices, the vast majority prefered plans that were better tailored to their individual health needs"

Long-term he said, "we must continue to reach on the outside to those who are not notwithstanding enrolled, especially low-income seniors." In addition, Leavitt noted, "We are working to incorporate Part D prescription remedy coverage into a larger strategy of prevention to improve the health of all Medicare beneficiaries.

"Too scarcely any seniors are having screening ordeals for cancer, diabetes and cardiovascular disease," he said, pointing to a priority for HH "Too scarcely any get physical exams. Too hardly any seek counseling and assistance to stop smoking.

"These simple services, all now overspreaded under Medicare, have the potential to save thousands of lives. We can and must dramatically increase the number of seniors who take advantage of Medicare's preventive benefits."

Leavitt called pharmacists "the untold heroes of the auspicious implementation of Part D. He said his agency and its Center for Medicare and Medicaid Services division would continue to work with the plans "to make secure that the legitimate concerns that pharmacists have squeeze outed related to timely payment and other billing issues are resolv promptly"

That critical aspect of Part D--just by what mode long it is taking prescription medicine plans administering the benefit to pay pharmacies for the Medicare prescriptions being dispensed--has snagged retail pharmacy and the managed care industry in another lengthy series of verbal jousts.

CM newly surveyed the major prescription remedy plans [PDPs] administering Part D around the political division on behalf of patients, and conclud that greatest in quantity were paying pharmacy claims promptly "The vast majority of PDP have contract boundarys that pay pharmacies within 30 days of the first day of the billing revolution of time and all PDPs have contract terminuss that generally lead to payment within 30 days," CM envoy administrator Leslie Norwalk told the House power and Commerce Health Subcommittee.

The Pharmaceutical Care Management Association, which exhibits the nation's pharmacy benefit management industry, quickly seized upon the findings. "These data confirm that pharmacists are being paid promptly in Medicare Part D just as they are in the commercial market, said PCMA President Mark Merritt. "Nonetheless, policymakers should be touched that this issue has become a Trojan horse for an extremely expensive agenda in which the medicine store lobby wins and consumer lose

"This agenda," Merritt charged, "includes mandating a six-fold increase in generic dispensing remunerations expensive changes in Medication Therapy Management programs and other provisions that would require to be paid [i]or[/i] undergone billions of dollars without offering any corresponding value in return

The National Community Pharmacists Association blasted those assertions. "Unfortunately, no like survey was ever conducted, and CM admitted the error the nearest day," NCPA stated. "CMS said the agency based its testimony upon informal information provided by the prescription-drug plans themselves. CM also acknowledged that pharmacists were not asked about their actual experience with moderate payments."

NCPA and the PCMA also clashed again last month above the merits of mail-order pharmacy. In testimony June 14 before the House Ways and Means Committee, Merritt called mail-service dispensing "an important tool for individuals managing chronic conditions" that "offer increased savings and patient compliance." He also asserted that mail order would save Medicare at least $78 billion above the next decade.