Medicare Prescription Drug Discount Cards Take Effect

The new Medicare prescription drug discount card program is set to debut Tuesday, as enrollment appears to continue to be slow, the New York Times/Detroit Free Press reports (New York Times/Detroit Free Press, 6/1). The discount card program, created as part of the new Medicare law, is available to Medicare beneficiaries who do not have prescription drug coverage through Medicaid. Beneficiaries have access to a number of discount cards sponsored by private companies and endorsed by Medicare. Card sponsors can charge an annual enrollment fee of as much as $30 and likely will offer savings on at least one medication in each of 209 classes of treatments commonly used by Medicare beneficiaries. Medicare beneficiaries with annual incomes of less than $12,372 for individuals or $16,608 for couples will qualify for a $600 annual subsidy for their prescription drug costs and will not have to pay enrollment fees. Beneficiaries can use the Medicare Web site or call 1-800-MEDICARE to make card-to-card comparisons of prescription drug discounts. According to HHS Secretary Tommy Thompson, the discount cards provide average savings of about 10% to 17% for brand-name medications and 30% to 60% for generic treatments (Kaiser Daily Health Policy Report, 5/28). The Bush administration has predicted that 7.3 million people will sign up for the discount card program this year. About 2.3 million beneficiaries in a Medicare managed care plan will be enrolled automatically (New York Times/Detroit Free Press, 6/1). In addition, Connecticut, Maine, Massachusetts, Michigan, New Jersey, New York and Pennsylvania are automatically enrolling seniors who participate in their state prescription drug assistance programs (Kemper, Los Angeles Times, 6/1).

Enrollment Numbers
So far, fewer than one million people in traditional, fee-for-service Medicare have signed up for cards, according to the Times/Free Press. CMS Administrator Mark McClellan said that the federal government does not have "precise enrollment counts" (New York Times/Detroit Free Press, 6/1). AARP said it has received "thousands of inquiries" about the drug cards, but only 400 people have signed up for its Medicare-approved discount card, according to the New York Times. Pharmacy benefit manager Medco said it was providing its Medicare-approved cards to 500,000 people; the Pharmacy Care Alliance said it is "on track" to its goal of enrolling 250,000 people; and the UnitedHealth Group said 200,000 beneficiaries had received its cards automatically.

Continuing Confusion
Observers say that ongoing confusion over the enrollment process has contributed to the slow enrollment, the New York Times reports. Forrester Research, a technology and market research firm, said in a recent report that the Medicare Web site that allows beneficiaries to compare discount cards is "riddled with flaws." Lucy Utt, director of the health insurance assistance program at the Tennessee Commission on Aging and Disability, added that it is "almost impossible to make a card selection without access to the Internet" (Pear/Freudenheim, New York Times, 6/1). Many seniors do not go online, according to the New Orleans Times-Picayune. Patricia Nemore of the Center for Medicare Advocacy said, "It's almost essential that you use the Web. It's difficult making a comparative decision without it. This is a benefit that will rely on a lot of people getting assistance from someone else" (Walsh, New Orleans Times-Picayune, 6/1). Leslie Norwalk, deputy administrator at CMS, said that the toll-free phone line has been overwhelmed with calls, adding, "[W]e'll admit to having a few glitches. We just didn't expect the volume" (Shelton, Orlando Sentinel, 6/10). Officials say the phone line has been receiving more than 150,000 calls per day and that the Web site is receiving about 1.6 million hits per day (Markley, Houston Chronicle, 6/1). According to Norwalk, wait times on the phone line average 15 minutes. She said that CMS has increased the number of phone line workers from 400 to 2,800 (Orlando Sentinel, 6/1). CMS official Michael McMullan said there have been "some bumps," adding, "the road is getting smoother" (New York Times, 6/1). Tricia Neuman, a Kaiser Family Foundation vice president and director of its Medicare Policy Project, said, "It's early yet, and it may take a while for seniors to hear about [the program] and develop some sense of comfort" (Orlando Sentinel, 6/1). Brian Glassman, a senior executive at Prime Therapeutics, which manages drug services for seven Blue Cross and Blue Shield plans offering cards, said that the confusion will grow when the full Medicare prescription drug benefit begins in 2006. He said, "You can take this market confusion and cube it" (New York Times, 6/1).

Savings Questioned
Most observers agree that low-income beneficiaries will benefit from the drug card program because of the $600 annual subsidy, the Los Angeles Times reports. But beneficiaries who do not qualify for the subsidy might be able to find better deals on prescription drugs elsewhere, such as through Canada, online pharmacies or state programs, according to some Democrats and consumer groups. The Maryland Department of Health and Mental Hygiene in April sent low-income beneficiaries a letter saying, "Do NOT sign up for the Medicare discount prescription card. You already receive higher savings with your state pharmacy benefit." Bill Pierce, a spokesperson for HHS, said federal officials were unaware of the Maryland letter and did not know if other states were advising beneficiaries similarly (Los Angeles Times, 6/1). Timothy Dickman, president of Prime Therapeutics, noted that in many cases, the rise in retail prescription drug prices over the last year had eliminated savings available through the drug cards. Rep. Pete Stark (D-Calif.) said, "The cards provide maximum confusion and minimum savings" (New York Times, 6/1). During a trip to Texas last week, House Minority Leader Nancy Pelosi (D-Calif.) said, "Drug companies have already begun increasing their prices so that they can offer 'discounts' without losing a dime in profits." However, House Majority Leader Tom DeLay (R-Texas) predicted that increased competition among drug card sponsors will increase savings for beneficiaries (Houston Chronicle, 6/1). The Access to Benefits Coalition, a new group of 68 organizations that is working with the federal government to enroll 5.5 million low-income beneficiaries, will soon release a state-by-state guide to drug benefits for seniors (Los Angeles Times, 6/1).

Bush Administration 'Downplaying' Law?
The often negative publicity surrounding the drug card program has caused the Bush administration to downplay the new Medicare law during public appearances, the Boston Globe reports. When the law was enacted in December, "White House aides seized on the image of a Republican president demonstrating his oft-noted compassionate conservativism and asserting some credibility on an issue Democrats had long used to their political advantage," the Globe reports. However, President Bush and Vice President Dick Cheney's remarks about the Medicare law have decreased from 22 mentions in December and January to four in February, five in March, one in April and three in May, according to a Globe survey. Ron Pollack, executive director of Families USA, said, "The president and the re-election campaign clearly felt that the enactment of this new law would be tremendously helpful in getting support from seniors. But this has clearly become a political boomerang." Bush campaign officials say the president is "not downplaying the prescription drug bill," adding that the war in Iraq and the economy have been more pressing issues in recent months, according to the Globe. Carroll Doherty, editor of the Pew Research Center poll, said that ongoing confusion among seniors about the new law gives the Bush administration an opportunity to educate them about its benefits. However, the Globe reports that such education would require Bush to make the law a bigger focus of his stump speech, which he has not chosen to do so far (Washington, Boston Globe, 5/31).

Broadcast Coverage

• C-SPAN's "Washington Journal" on Tuesday included an interview with Kate Schuler, health policy reporter for Congressional Quarterly, and Tom Paul, president of the pharmacy services program at AARP, about the Medicare prescription drug discount cards taking effect ("Washington Journal," C-SPAN, 6/1). The complete segment will be available online in RealPlayer and Windows Media after the broadcast.
  
• MPR's "Marketplace Morning Report" on Tuesday also reported on the discount cards. The segment includes comments from Howard Houghton, coordinator of Fairfax Area Agency on Aging's Virginia Insurance Counseling and Assistance Program (Scott, "Marketplace Morning Report," MPR, 6/1). The complete segment will be available online in RealPlayer after the broadcast.
  

Other Print Coverage
Several other newspapers recently examined the launch of the prescription drug discount card program.

• "Medicare Drug Cards Activated" (Akron Beacon Journal, 6/1).



• "Few Have Enrolled in Medicare Drug Cards" (AP/Houston Chronicle, 5/29).



• "Prescribed Confusion: Medicare Drug Card Program Frequently Baffling to Seniors" (Miller, Atlanta Journal-Constitution, 5/30).



• "Drug Card Program Kicks Off" (Wheeler, Gannett/Indianapolis Star, 6/1).



• "Pharmacists Say Medicare Web Site Confuses" (Gilgoff, Long Island Newsday, 5/31).



• "Seniors Stick to Plan They Have" (Barfield Berry, Long Island Newsday, 5/30).



• "Picking Medicare Card Not Simple" (Nygren, Omaha World-Herald, 5/31).



• "Medicare Discount Drug Card Isn't Big Seller" (Snowbeck, Pittsburgh Post-Gazette, 6/1).



• "Medicare Expects Few Seniors Will Use Discount Cards" (Bowman, Scripps Howard/Washington Times, 5/29).



• "Baffled Seniors Seek Drug-Card Guidance" (Bjerga, Wichita Eagle, 6/1).