CMS unveils plan for Medicare drug benefit but skimps on details

Government officials tout the expected savings for beneficiaries, but experts worry that a lack of specifics could spark confusion.

By Joel B. Finkelstein, amednews staff. Aug. 16, 2004.

Washington -- Medicare beneficiaries are another step closer to being offered comprehensive drug coverage with the recent release of a proposed regulation for the new program, but many questions still remain about the benefit.

One is how patients will receive medications that are not on their plan's formulary, said Haiden Huskamp, PhD, assistant professor of health economics in the Dept. of Health Care Policy at Harvard Medical School.

According to Centers for Medicare & Medicaid Services Administrator Mark McClellan, MD, PhD, "If a physician thinks an uncovered drug is urgently needed, the drug would be covered while a prompt exception process is completed."

But how will the appeal process be handled and will companies be bound by that decision, Dr. Huskamp asked. The regulation does not get into those details, she said.

Government officials did spell out how the new benefit, which kicks in Jan. 1, 2006, will help beneficiaries afford their medications.

"For seniors without drug coverage, this is real and significant savings that will help them cut their bills in half, and not their pills," said Health and Human Services Secretary Tommy Thompson.

On average, the benefit will cover about half of beneficiaries' prescription drug costs for those currently without coverage, according to CMS estimates.

The proposed rule closely follows the Medicare reform law passed last year, which allows seniors to enroll in a stand-alone prescription drug benefit or join a managed care plan that includes drug coverage.

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