Complaints Over Medicare Rx Benefit Average 2.3 Per 1,000 Beneficiaries, CMS Says
CMS in June received about 2.3 complaints related to the Medicare prescription drug benefit for every 1,000 beneficiaries enrolled in Medicare drug plans, according to data released by the agency on Wednesday, CQ HealthBeat reports. The agency received about 2.6 complaints per 1,000 beneficiaries enrolled in stand-alone prescription drug plans and about 1.4 complaints per 1,000 beneficiaries enrolled in Medicare Advantage plans, the data show. CMS divided complaints in four categories: benefits and access, enrollment and disenrollment, pricing and co-insurance, and "other." According to CMS, most of the complaints were related to enrollment or disenrollment in drug plans, while an average of less than one complaint per 1,000 beneficiaries related to problems that beneficiaries faced obtaining needed drugs or plan customer service (Carey, CQ HealthBeat, 7/19). In addition, "[v]ery few beneficiary complaints involve other issues like problems with the exceptions or appeals process," CMS said (CMS release, 7/19). CMS said the data will be used to find plans' problems and to address problems in customer service. Plans with high complaint rates that do not improve over the next month could face fines or restrictions on their enrollment abilities, CMS Administrator Mark McClellan said (CQ HealthBeat, 7/19).
Comments
HHS Secretary Mike Leavitt said, "The relatively low number of complaints that we are receiving from beneficiaries is another indication that the vast majority of beneficiaries are getting a high level of service," adding, "While this is an important result, we are making sure that complaints and any underlying problems are being addressed and resolved as quickly as possible" (Hundley, St. Petersburg Times, 7/20). Rep. Pete Stark (D-Calif.) said the data "cannot mask the Medicare prescription drug program's serious shortcomings," adding, "Even accepting the agency's numbers, an average rate of 2.3 complaints per 1,000 beneficiaries translates into nearly 30,000 people dissatisfied." Karen Ignagni, president and CEO of America's Health Insurance Plans, said the data "validate the fact that (beneficiaries') experiences are positive." She added, "This is a solid baseline going forward" (CQ HealthBeat, 7/19).
Complete CMS data on complaint rates for beneficiaries enrolled in Medicare Advantage plans is available online. Complete data on complaint rates for beneficiaries enrolled in PDPs also is available online. Note: You must have Adobe Acrobat Reader to view the charts.
