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Settlement to Ease Drug Costs for Some on Medicare
By Robert Pear, New York Times
June
20, 2008
The Bush administration promised on Thursday to provide new protections for low-income Medicare beneficiaries to ensure they can get prescription drugs promptly, at minimal cost.
The promise came in the proposed settlement of a nationwide class-action lawsuit filed on behalf of hundreds of thousands of people who have had difficulty getting the medicines they need.
Under the 2003 Medicare law, more than six million people eligible for both Medicare and Medicaid are entitled to extra help with their drug costs. But in many cases, they could not get the assistance, so they did not receive the drugs they needed, or they experienced long delays.
In early 2006, low-income beneficiaries were often overcharged, and some were turned away from pharmacies without getting their medications. Several states declared public health emergencies, and many stepped in to pay for prescriptions that should have been covered by the federal Medicare program.
Under the proposed settlement, filed Thursday with the United States District Court in San Francisco, federal Medicare officials promised to speed up the process of providing extra help to low-income people, who now could qualify within days, rather than weeks or months.
Drug benefits are delivered by private insurers under contract to Medicare. Under the settlement, these insurers will have to provide medications at minimal cost for any Medicare recipients who prove they have low incomes and qualify for extra help.
For most people with incomes less than the poverty level ($10,400 a year for an individual), the maximum co-payment is $1.05 for a generic or preferred brand-name drug and $3.10 for other prescription drugs.
But many beneficiaries have been asked to pay much higher amounts, from $30 to $75 or more, because the evidence of their low-income status was not properly shared among federal and state agencies, insurance companies and pharmacies.
“This settlement agreement is a victory for many of the nation’s most vulnerable citizens, who have faced life-threatening delays in obtaining vital medications,” said Kevin Prindiville, a lawyer at the National Senior Citizens Law Center, which filed the lawsuit with another nonprofit group, the Center for Medicare Advocacy.
Gill Deford, a lawyer at the Center for Medicare Advocacy, said the settlement would “help hundreds of thousands of people a year get their prescription drugs more quickly, at nominal cost.”
Jeff Nelligan, a spokesman for the federal Centers for Medicare and Medicaid Services, said federal officials had “worked tirelessly” to ensure that Medicare recipients could fill their prescriptions. He refused to comment on the substance of the settlement, noting that it was subject to approval by Judge Thelton E. Henderson of Federal District Court in California.
States administer the Medicaid program. They have crucial information showing whether Medicare beneficiaries are also enrolled in Medicaid and therefore eligible for extra help with their drug costs.
Under the settlement, if a beneficiary claims to be eligible for the low-income subsidy but does not have the documents to prove it, and if the person is about to run out of a medication, federal officials would immediately contact the state Medicaid agency to check whether the person had been on Medicaid.
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