Gov't Announces Extra Steps to Ensure Drug Coverage for Poor

WASHINGTON – Two weeks after being sued, the government said Thursday it put in place more safeguards to ensure that poor older people can fill their drug prescriptions on Jan. 1.

In recent weeks, the government automatically has enrolled about 6 million people in private plans that will offer a new drug benefit under Medicare. The people in this category are called dual eligibles because they qualify for both Medicare and Medicaid.

Even if the government misses enrolling just 1 percent of them, that means about 60,000 people potentially would have no prescription drug coverage come the new year.

To address that, federal officials said the Centers for Medicare and Medicaid Services has contracted with two companies. When a customer enters a store, pharmacists will check with one contractor — Z-Tech Corp. of Rockville, Md. — to determine the customer's eligibility for drug coverage.

The pharmacists can bill a second contractor, Wellpoint Inc. of Indianapolis, which will enlist the customer in one of its drug plans.

"They'll be able to leave the pharmacy with their prescription in hand, even if there is not immediate evidence of what plan they're in," said the agency's administrator, Mark McClellan.

McClellan's announcement came after eight advocacy groups sued to continue existing drug coverage for the dual-eligibles until those beneficiaries are enrolled in a plan that meets all their prescription needs.

About one-quarter of the dual eligibles live in nursing homes. About 40 percent of them have dementia or other impairments.

McClellan said the announcement was unrelated to the suit.

Deanne Beebe, a spokesman for one of the plaintiffs, the Medicare Rights Center, said the groups would continue with the suit until they are assured that every dual-eligible person "who leaves the pharmacy leaves with the prescriptions they came to fill."

CMS spokesman Gary Karr said Wellpoint was chosen because it has a pharmacy network in all 50 states. Its contract does not have a specific value because it will depend on how many beneficiaries are placed into their drug plan. Z-Tech's contract is valued at about $1.6 million.