In order to immediately eliminate the gaps in prescription drug coverage that low-income seniors and individuals with disabilities are experiencing, Democratic senators have introduced the Requiring Emergency Pharmaceutical Access for Individual Relief (REPAIR) Act. This comprehensive legislation will:

Provide Guaranteed Access to Prescription Drugs

• Require plans to include a minimum 30-day first-fill in their transition policies. As a condition of participation in the Medicare prescription drug program, all plans will be required to provide at least a 30-day supply of prescription drugs that beneficiaries were taking prior to their enrollment in a particular plan. This 30-day minimum supply will apply to new enrollees to Medicare as well as to beneficiaries who switch to new plans.
  
• Allow presumptive eligibility for dual eligibles at the point-of-sale. Individuals who present at a pharmacy anywhere in the country with their government-issued picture identification card, their Medicaid card, and reliable evidence of Medicare enrollment shall be presumed eligible for the Medicare prescription drug benefit as dual eligibles by pharmacists and should be treated as protected under MMA guidelines. Presumptive eligibility shall apply in cases where pharmacists cannot verify dual-eligible status through the E-1 billing system or the point-of-sale plan. Dual eligibles who are presumed eligible for Medicare prescription drug coverage will be eligible for the minimum 30-day transition prescription. Pharmacists will be able to bill the Centers for Medicare and Medicaid Services (CMS) directly for such prescriptions.
  
• Require CMS to clearly identify dual eligibles in electronic data files shared with plans. For each calendar year, CMS will be required to identify, on the Medicare enrollment database, dual eligible status that has been verified with the states. Dual eligible status shall be reflected on each data file necessary to ensure that such status is transmitted to plans when CMS certifies enrollment in such plans and accessible to pharmacists during E-1 queries or point-of-sale encounters.

Provide Additional Protections for Low-Income Medicare Beneficiaries

• Prohibit states from conditioning continued Medicaid eligibility on enrollment in Medicare Part D for certain individuals. States will be barred from conditioning continued Medicaid eligibility for dual eligibles on enrollment in a Medicare prescription drug plan if such individuals also have other forms of insurance that would count as credible coverage under Medicare Part D. Such forms of credible coverage include employer-sponsored retiree coverage as well as Veterans health benefits.

Improve Customer Service

• Require CMS to station one trained employee at every SHIP through the open-enrollment period. Given the mass confusion surrounding this benefit, this legislation requires CMS to station one employee at every state SHIP office through May 15, 2006, in order to help beneficiaries and SHIP counselors better understand the Medicare drug benefit.
  
• Require CMS to make the appropriate expenditures necessary to hire additional trained professionals to reduce 1-800-MEDICARE call wait times.

Reduce the Burden on Pharmacies

• Require CMS to provide additional outreach and education to pharmacies. Many pharmacies, particularly independent pharmacies in rural parts of the country, are unaware of the E-1 billing system and how to use it. This legislation will require CMS to provide additional outreach to every pharmacy participating in the Medicare drug program on both the E-1 billing system and the point-of-sale plan.
  
• Hold pharmacies harmless for the transaction costs associated with the E-1 billing modification. Pharmacies will be able to receive federal reimbursement for any transaction fees related to the point-of-sale enrollment process and technology or software upgrades necessary to make identification and enrollment inquires.
  
• Allow pharmacies to bill CMS directly for the costs of providing a transitional supply of prescription drugs to dual eligibles. Pharmacies will be able to bill CMS directly for the costs associated with providing a transitional supply of prescription drugs to dual eligibles presumed eligible based on the standards listed above and for which pharmacies are unable to get verification of status from the E-1 billing system or point-of-sale plan.

Provide Federal Reimbursement to States and Beneficiaries

• Require CMS to provide compensation to dual eligibles incorrectly charged premiums, deductibles or other cost-sharing above statutory limits. Dual eligibles who have incorrectly been forced to pay premiums, deductibles and coinsurance in violation of the Part D statutory limits will be eligible for compensation from CMS. CMS will use claims data to track beneficiaries who were inappropriately charged and reduce payments to the plans beneficiaries where enrolled in at the time of the charges. For beneficiaries inappropriately charged while unassigned to a plan, CMS shall develop a separate process for reimbursement. Refunds will be issued directly to the beneficiary, either through a rebate on future Social Security checks or through a direct payment.
  
• Require CMS to provide full reimbursement to states who incurred unexpected costs filling the gaps of this federal benefit. CMS shall fully compensate states for all funds spent to provide continued access to prescriptions for Medicare beneficiaries in 2006.