Washington – Organizations representing people with physical and mental disabilities urged Medicare on Wednesday to strengthen consumer protections significantly under its new prescription drug benefit.
They called on the heath-care program for the elderly and disabled to guarantee prompt reimbursement for patients who have been overcharged and to require that all insurers follow simple standard rules for appeals when denying coverage of a particular medication.
“We are very unhappy with how things are turning out,” said Kirsten Beronio of the National Mental Health Association. “In general, (Medicare) has been addressing problems on a case-by- case basis, instead of treating them as the systematic problems that they are.”
Groups that joined in the call for immediate reforms included the Epilepsy Foundation, Paralyzed Veterans of America and United Cerebral Palsy.
The chief medical officer for the Medicare division that handles the drug benefit said the agency was responding to the concerns.
“We have made a lot of effort to work with the disability groups and the mental-health groups because they represent a very vulnerable and important population to bring into the benefit,” Dr. Jeff Kelman said.
But advocates for the disabled said Medicare’s directives to the private insurers that provide the drug coverage are ignored sometimes, since they are issued only as guidelines and thus lack the force of federal regulations.
While millions of beneficiaries have gotten their prescriptions with no trouble, the program got off to a stumbling start last month after several hundred thousand patients ran into billing problems at pharmacy counters. In many cases, pharmacists could not determine whether a person was covered. In others, patients were charged too much.
Health and Human Services Secretary Mike Leavitt said this week that about 3 percent to 5 percent of beneficiaries are having such problems the first time they visit the pharmacy, compared with about 10 percent of beneficiaries last month. The lower figures still mean that tens of thousands of seniors and disabled people are having difficulty.
Although advocates agreed the number of complaints had dropped significantly, they said some individual cases were more serious, involving frustrated patients who have gone without medications for several weeks, including mentally ill and cardiac patients who then had to be hospitalized.
