States Offering Temporary Drug Coverage to Aid Transition to Medicare Part D
During the first few weeks that Medicare Part D has been in effect, there has been much confusion at the pharmacy counter. One area of particular concern has involved glitches in the transition of dual Medicare/Medicaid eligibles’ drug coverage from Medicaid to Medicare. There have been numerous reports of dual eligibles being charged incorrectly, being improperly asked to pay deductibles, not being listed in plans they thought they were enrolled in, and leaving pharmacies without the prescriptions they need.
Several states have stepped in to help by offering to temporarily pay for prescriptions for dual eligibles—and sometimes other low-income residents—who are experiencing problems getting their medications filled through Medicare.
As of February 6, 2006, the states listed below had taken action. The list of states that are stepping in to help is growing daily. For a table summarizing state actions, click here.
Alabama: On January 13, Governor Riley directed the Alabama Medicaid Agency to help senior citizens who are having problems receiving their prescription medications because of the recent implementation of the Medicare Part D prescription drug program. Click here for more information.
Arizona: On January 13, Governor Napolitano issued an order to transfer as needed $500,000 (in increments of $50,000) from the Health Crisis Fund to the Arizona Health Care Cost Containment System (AHCCCS) to pay for prescriptions for full dual eligibles who may have problems with coverage during the period from January 1, 2006–February 1, 2006 (to be extended if needed by further Executive Order). Click here for more information.
Arkansas established a temporary program on January 11 to pay the costs of providing prescription drugs for dual eligibles who are having difficulty getting their drugs filled through Medicare. Click here for more details. The press release announcing this program says that the order will reimburse pharmacists for costs for dual eligibles for the first two weeks of January, and that Arkansas will reassess the needs of this group on a weekly basis. The executive order itself does not contain a timeline.
City of Baltimore: As part of its Medicare Part D Surveillance and Response initiative, the city Health Department has set up a $50,000 reserve fund to cover emergency prescriptions for low-income patients until problems with Medicare Part D coverage are resolved.
California: Governor Schwarzenegger signed an emergency measure on January 13 directing the state DHS to implement a five-day emergency program to pay for prescription drugs for beneficiaries who have been unable to obtain them through Medicare. To receive reimbursement, a pharmacy must certify that it was either unable to obtain necessary information from Medicare to submit a claim, that its claim was incorrectly denied, or that the beneficiary's deductible or copayment was higher than the $1 to $5 amount established by Medicare. The governor will ask the federal government to reimburse the state for the cost of this emergency program. State lawmakers have also drafted a bill, which is expected to reach the governor for consideration on January 19, that would extend the five-day measure for as long as 30 days. On January 20, the emergency program was extended for 30 days. See the press releases for January 12, 13, 17, and 20.
Connecticut on January 9 extended by one week its emergency legislation to pay the drug costs incurred by low-income residents who encounter eligibility problems at the pharmacy. The initiative applies to 75,000 citizens who are either transitioning from Medicaid to Medicare or who are covered by Connecticut's state pharmacy assistance program. Connecticut enacted a law (introduced as H.B. 7702 in 2005) to assist dual eligibles with copayments and enrollment in Part D plans. The legislation is available online.
District of Columbia Mayor Williams announced on January 18 that the District would shift $3 million from its contingency fund in order to cover the cost of drugs for dual eligibles who are being charged more than $1 or $3 for drugs. The measure is scheduled to last 90 days. Click here for more information.
Florida: On January 26, Governor Bush issued an Executive Order announcing that the state will pay for a 30-day supply of emergency drugs for Medicaid beneficiaries transitioning to Medicare Part D who encounter problems getting their drugs. Click here for more information.
Hawaii implemented a contingency plan last year as follows: The state pays the drug costs of any dual eligible resident who has trouble getting his or her drugs during the transition from Medicaid to Medicare. As of early January, the state has spent $33,000 covering drugs for 446 people. The program was originally set to operate for a month, but it may be extended into February.
Idaho is covering the cost of critical, expensive drugs for dual eligibles on a case-by-case basis. The state's Department of Healthcare and Family Services is taking calls on its pharmacists hotline about problems pharmacists are having filling prescriptions for low-income seniors and disabled people in Medicare. If a problem cannot be resolved, pharmacists will be allowed to bill the state for the prescription. The termination date of this program has not been set. Click here for more information.
Illinois: On January 12, Governor Blagojevich announced that Illinois would cover the cost of prescription drugs for dual eligibles—those enrolled in both Medicare and Medicaid—who were otherwise being turned away from pharmacy counters due to glitches in the new Medicare Part D drug program. Click here for more information.
Kansas Governor Sebelius announced that, starting January 13, if a pharmacist is having trouble enrolling someone who is considered dually eligible for Medicare and Medicaid, or if there are problems with their claims, the state will cover the cost of the prescription drugs directly. Kansas will seek appropriate compensation from the Centers for Medicare and Medicaid services or from the health plans that failed to properly enroll the individual. Click here for more information.
Maine Governor Baldacci has announced that the state will pay drug claims for low-income beneficiaries until CMS finds a solution to the problems beneficiaries are encountering. Maine is providing one-month prescription fills for several weeks. Since January 3, the state has incurred $2 million in expenses related to the drug benefit. Maine is reenrolling dual eligibles in the plans that provide the best coverage for them. The governor's press release is available online.
Maryland is providing assistance for dual eligibles who are experiencing difficulties in getting their medicines under the new federal Medicare Part D program. Click here for more information.
Massachusetts on January 9 authorized state payment for medications for dual eligibles and those in the state’s pharmacy assistance program who were unable to get their prescriptions filled through Medicare Part D. This program is estimated to cost the state between $1.5 and $2 million a day. Massachusetts' law allows for a one-time, 30-day supply with a subsequent 72-hour emergency supply of prescribed medicines. Click here for more information.
Minnesota Governor Pawlenty issued an Executive Order declaring that, from January 15 through February 17, the state will pay for prescription drugs for dual eligibles who cannot obtain their medications through Medicare. The governor has said that he does not expect the federal government to reimburse the state and would like to use the state’s Health Care Access Fund to help pay for the costs. Click here for more information.
Missouri: The Department of Social Services has established procedures, at the governor’s request, to override Medicaid denials for drug coverage for dual eligibles. Missouri's Emergency Override Plan will temporarily restore Medicaid prescription drug coverage in critical cases where access to the federal Medicare program cannot be achieved in a timely fashion. Click here for more information.
Montana: DPHHS will cover the costs of prescriptions for dual eligibles until issues with the new Medicare prescription drug plans are resolved. Click here for more information.
Nevada: Senior Rx, the state’s prescription drug assistance program for more than 9,000 low-income senior citizens, has set up a one-month transition period for participants to continue to get their prescriptions filled. Nevada will decide by the end of the week of January 12 whether to provide additional financial aid to dual eligibles. Governor Guinn has asked CMS for more information before the state decides whether to pay for prescription drugs for dual eligibles. According to the governor’s staff, the state has provided medications to some Medicare beneficiaries on a case-by-case basis. See “Anticipating plans for Rx Problem” by Ryan, Las Vegas Sun, January 12, 2006.
New Hampshire enacted emergency coverage on January 6 to pay for drugs when Medicare Part D does not work for state residents. See the governor’s press releases from January 6 and January 10.
New Jersey is temporarily paying drug costs for state pharmacy assistance program enrollees and for dual eligibles who have problems getting their drugs through Medicare Part D. In the first days of the operation of the temporary program, the state spent state spent $4.7 million covering the cost of 52,000 claims for dual eligibles.
New York: On January 13, Governor Pataki directed the Department of Health to pay the costs of prescription drugs for full dual eligibles for a period of seven days when pharmacists are unable to obtain appropriate coverage through Medicare Part D. Beginning February 16, 2006, the New York state Medicaid program will provide a new interim billing verification process, which will allow continuation of Medicaid payments for full benefit dual eligibles between February 16 and March 8, 2006. After March 8, 2006, all temporary and interim coverage by Medicaid of Part D covered drugs will end, and only “wrap-around” claims with a Medicare Verification System number will be reimbursed for full benefit dual eligibles. Click here for more information.
North Dakota is providing an emergency 30-day supply for dual eligibles who cannot get their medications through Medicare Part D. This temporary program is scheduled to run through January 23. After that, it will continue on a case-by-case basis until February 15. Click here to read the governor's press release.
Ohio: Governor Taft has directed the Ohio Department of Job and Family Services (ODJFS) to guarantee to pay pharmacists the difference between the amounts charged and proper copayments. This directive will remain in effect until the end of January. At that time, the state will review the situation and determine if further assistance is necessary. ODJFS will communicate directly with pharmacies regarding the details of this effort. Click here to read the governor’s press release.
Oregon: Governor Kulongoski has executed an emergency relief plan to provide temporary assistance to the thousands of Oregon Medicare/Medicaid beneficiaries currently being denied access to critical medications as a result of administrative failures under the new Medicare prescription drug benefit. The state will reimburse pharmacies for a 30-day supply of medication if the pharmacist is not able to bill Medicare or one of the benefit plans. The governor's plan is expected to help about 100 Oregon dual eligibles per day. The state will seek reimbursement from the federal government for those costs. Click here for more information.
Pennsylvania Governor Rendell authorized the state to cover drug costs for individuals who can identify themselves as eligible for Medicare’s low-income subsidy (LIS) but who do not appear as LIS-eligible in the state's pharmacy system for Medicare Part D claims. This authorization extends to January 31. At that time, the situation will be reassessed. Additionally, on January 16, the governor asked pharmacies to provide a five-day emergency supply of prescription drugs to those who are eligible for Medicare Part D but who are still having problems getting their medications. Click here to read the governor’s press release.
Rhode Island reactivated its Medicaid prescription drug coverage for all 27,000 dual eligibles. If a dual eligible’s prescription is rejected, or if the copayment is higher than the required $1 for generic drugs and $3 for brand-name drugs, the pharmacist should bill the state Medicaid program, the Rhode Island Medical Assistance Program. The termination date of this arrangement has not been set. Click here for more information.
South Dakota has announced that it will pay for a 30-day supply of emergency drugs for Medicaid beneficiaries transitioning to Medicare Part D who encounter problems getting their drugs. This program will be in place until January 27. Click here for more information.
Texas: On January 25, Governor Perry issued an Executive Order announcing that the state will pay for a 30-day emergency supply of prescription drugs for Medicaid beneficiaries transitioning to Medicare Part D who encounter problems getting their prescriptions filled. Click here for more information.
Utah will cover prescriptions for dual eligibles for 30 days. For more information, see "Plugging Medicare Holes," The Salt Lake Tribune, January 14, 2006.
Vermont passed a bill on January 5 authorizing the state to pay for interim drug costs of its dual eligible and state pharmacy assistance program enrollees. The program will operate until February 10. Data from the first three days of the initiative indicate that the state is spending about $250,000 a day to cover residents' drugs. Vermont's law is available online.
Virginia: Governor Kaine authorized Virginia Medicaid to cover claims for drugs designated under the Medicare Part D drug benefit for dual eligible beneficiaries with Medicare and full benefit Medicaid coverage if pharmacists are unable to process these claims through the Medicare Part D Prescription Drug Plans (PDPs) or other designated payment methods. This action does not apply to limited coverage groups (Qualified Medicare Beneficiaries, Special Low Income Medicare Beneficiaries, Qualified Individuals). Click here for more information.
Wisconsin: Governor Doyle announced on January 13 that if a pharmacy has not been able to bill the Medicare Prescription Drug Plan through normal processes and procedures, it can submit a claim form to Wisconsin’s Medicaid program, including information on the steps it has exhausted in trying to successfully bill Medicare Part D. Pharmacies that fill a 30-day prescription and have tried to obtain payment under Medicare Part D can submit a one-time claim to Wisconsin’s Medicaid program for payment. The state will pay the claims and then seek federal reimbursement. If necessary, the state will demand that the federal government provide any assistance necessary to recoup or cover these costs. Click here for more information.
Updated January 24, 2006.