CMS Reminds Drug Plans They Must Provide
Medicare Beneficiaries with 30-Day Initial Supply of
Medications, Even if not Covered by Plan
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On January 20, the Centers for Medicare and Medicaid
Services (CMS) sent a directive to insurers that offer
Medicare prescription drug benefit plans, instructing
them that they are required to provide beneficiaries
a 30-day emergency supply of any drugs they were taking
before the Medicare prescription drug benefit began
Jan. 1, the "New York Times" reports. In addition,
the directive says insurers "must take immediate
steps" to ensure that no low-income beneficiary
is charged more than $2 for a generic drug and $5 for
a brand-name drug. The directive states, "We must
stress that delaying or denying the filling of initial
prescriptions for new enrollees at point-of-sale ...
is not consistent with the intent of CMS transition
policy." The directive also urges insurers to dedicate
phone lines to pharmacists' calls about the drug benefit
in order to reduce waits. Such phone lines "will
reduce the wait times for beneficiaries and pharmacists
in order to avoid any beneficiary leaving the pharmacy
without prescriptions," the directive states.
Comments
Jeff Flick, western regional administrator
for CMS, said some pharmacists were unaware of the 30-day
supply requirement. "The idea behind this is, we
wanted to be sure that whatever they were taking in
December, they can get in January," Flick said.
He continued, "Once they have the first fill, now
they have 30 days to talk it over with their doctor.
The point is, everybody has time for this transition,"
adding that CMS held conference calls with pharmacists
to advise them of the directive. In addition, he said,
"we gave guidance to all of the (drug) plans to
please make sure all of the pharmacies that you contract
with understand the first-fill commitment." CMS
spokesperson Gary Karr said some beneficiaries who are
dually eligible for Medicaid and Medicare might have
encountered problems because of a glitch that removed
some dual eligibles from the list of enrolled beneficiaries.
Medicare officials sent an updated list of dual eligibles
to insurers, he said, adding, "We are examining
our systems to make sure there is not some hole where
people are not getting picked up." Melissa Shannon,
consumer health policy coordinator for Health Care for
All, said, "I'm glad to see them take this step.
I'm just not sure how much it will help."
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Today"
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