While I did not support this legislation, Medicare recipients became eligible for the prescription drug coverage benefit on January 1, 2006 and deserve access to medications as promised by legislation signed into law in 2003.  Suffice it to say, after over two years of preparation, I am extremely disappointed that a number of problems have cropped up immediately and beneficiaries are being denied access to medications upon which their lives depend.

Perhaps the biggest problem with the Medicare Part D prescription drug benefit launched just weeks ago is the group of beneficiaries referred to as the dual eligible population; those eligible for both Medicare and Medicaid coverage.  As of January 1, 2006, Medicaid beneficiaries were supposed to have their prescription drug benefit shifted to the Medicare Part D prescription drug coverage.  Unfortunately, there has been a huge snafu in the electronic system in that Medicaid beneficiaries are not in the system at all or have been wrongly classified as a standard Medicare beneficiary and are subsequently being charged significantly higher co-payments than what is allotted for a Medicaid beneficiary.

As a result, pharmacists across the country are faced with a dilemma.  They must either deny necessary prescriptions to Medicaid beneficiaries or the pharmacists must absorb these out of pocket expenses to pay for the cost of the prescriptions while kinks in the system are being ironed out and they are hopefully reimbursed.  Either way, an unfair fiscal burden has been placed on the shoulders of both Medicaid beneficiaries and pharmacies throughout the country by a federal program that had two years to prepare.

In a bipartisan manner, I have joined Senators Blanche Lincoln and Mark Pryor, along with U.S. Representatives Marion Berry, Vic Snyder, and John Boozman in sending a letter to Mark McClellan, the Administrator of the Centers for Medicare and Medicaid Services (CMS), requesting his immediate attention to this serious problem facing Medicaid beneficiaries throughout the country.  

I commend the Attorney General and the Governor of Arkansas for their efforts in authorizing the Arkansas Department of Health and Human Services to reimburse the State Medicaid program so that pharmacists are allowed to bill Medicaid – as they did just weeks ago - for prescription drugs for dual eligibles either incorrectly identified or not at all in the system.  At least four states – Maine, New Hampshire, Vermont, and North Dakota – have instituted this plan.  Taking this one step further, I have sent an additional letter to Mark McClellan, requesting that Medicare reimburse states for Medicaid costs incurred while problems in the new Medicare Part D prescription drug plan are being ironed out.  Such action would ensure that beneficiaries receive their medications in a timely and effective manner, as well as relieve the fiscal burden that they and pharmacists are facing.  

As your Representative in the United States Congress, I will always side with the people I represent in Arkansas’s Fourth Congressional district and continue to be your voice in our nation’s capitol.  I look forward to what will hopefully be a timely response and adequate solution from CMS.  Access to life saving medications should not be limited, and I will continue to work to ensure that all citizens have fair access to the Medicare Part D prescription drug benefit. 

The text of the letter is provided below.
 

January 12, 2006
 

Mark McClellan, M.D., Ph.D.
Administrator
Centers for Medicaid and Medicare Services 
314 G Hubert H. Humphrey Building
200 Independence Ave, SW
Washington D.C.  20201
 

Dear Dr. McClellan:

As you are aware, the recently implemented Medicare Part D system has posed a series of problems for both beneficiaries and pharmacists.  Since the start of the program twelve days ago, thousands of dual eligibles have been faced with obstacles in obtaining needed medications. These beneficiaries either have not been entered into the system or have been wrongfully classified as standard Medicare beneficiaries therefore being subject to substantially higher co-payments.

Local pharmacists have been working endlessly to assist these beneficiaries in obtaining needed medications. Some of the pharmacists in our state have gone as far as absorbing the cost of these beneficiaries’ medications in the hopes of being reimbursed once the problems with the system are resolved.  Others simply cannot afford to bear this financial burden and continue to keep their doors open.  As a result, they have had to deny beneficiaries their prescriptions. Consequently, beneficiaries are losing access to needed life-saving medications.  Lack of medicine or disruption in medication routine will ultimately lead to increased doctor and hospital visits, therefore creating unnecessary increased costs to our health care system. 

In light of this situation, Governor Huckabee has issued an executive order to use operating funds from the Arkansas Health and Human Services Department to reimburse pharmacists who are unable to properly bill the Medicare Part D health plans.  We are pleased with the Governor's action, as it will ensure that beneficiaries' prescriptions will be filled and pharmacists will be reimbursed.  Under the executive order, the state will provide this funding from January 1st through January 15th.  We ask that you ensure that Arkansas is reimbursed for the costs the state is incurring during this time.

We appreciate your attention to this matter and look forward to your response on how the Centers for Medicaid and Medicare Services is resolving this serious problem facing beneficiaries and pharmacies across our nation.