Medicare and Part D
PI ACTION ALERT:
MEDICARE PART D UPDATE:
Emergency Coverage for California's Medi-Medis
January 13, 2006
California will provide emergency coverage for people who are dually
eligible for Medicare and Medi-Cal (California's Medicaid) and experiencing
problems accessing their drugs under Medicare Part D.
If a pharmacist has tried to get prescription drugs under the beneficiary's
Medicare plan and been denied or the beneficiary is being charged
co-pays that are higher than the $1–$5 co-pay that are charged
to dual eligibles, the pharmacist should bill Medi-Cal. The California
Department of Health Services is working to ensure that dual eligibles
do not leave the pharmacy without necessary prescription drugs.
Instructions to pharmacists are posted on www.medi-cal.ca.gov.
BACKGROUND
As of January 1, 2006, Medicaid coverage of prescription drugs ended
for people who rely on both Medicaid and Medicare. Coverage under
Medicare Part D began. Unfortunately there have been many problems
with implementation of the new Medicare drug benefit. The Centers
for Medicaid and Medicare Services (CMS), the federal government
agency that oversees Medicaid, admitted to a 20% error rate in eligibility
issues for the new benefit and many are estimating a much higher
percentage of problems. Due to an array of problems, as many as
20% of dual eligibles in California have been unable to access essential
medications.
California, along with a growing number of states, has announced
that it will use its Medicaid program to provide a temporary supply
of medications for dual eligibles who are unable to get their prescription
drugs. The initial period of Medi-Cal coverage will be 5 days. The
Department of Health Services will also seek emergency legislation
to provide a total of 15 days of prescription coverage. Medi-Cal
coverage is intended to be the payer of last resort so people should
still try to get their drugs from their Medicare plans. Failing
that, pharmacists can bill Medi-Cal.
More details about the emergency coverage will follow as the Legislature
considers the legislation submitted by the administration.
