Washington – The Bush administration issued a new policy on Wednesday that protects Medicare beneficiaries against the sudden loss of coverage for drugs they are taking under the prescription drug program.
Under the policy, insurers can still change their lists of covered drugs, known as formularies. But if they drop any drugs or impose new restrictions, they must exempt beneficiaries who are now taking those drugs.
Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services, summarized the policy: “In general, a plan cannot change your coverage for the drugs you are using during the year. The stability of drug formularies is extremely important for many of our beneficiaries.”
The policy addresses one of the chief criticisms of the Medicare drug benefit.
Democrats and a few Republicans in Congress had said it was unfair that drug plans could change their formularies at will while most beneficiaries were locked into a drug plan for the full year. The new policy says, “No beneficiaries will be subject to a discontinuation or reduction in coverage of the drugs they are currently using,” with some limited exceptions.
An insurer could, for example, remove a drug from its list if new research showed that the drug was unsafe for some patients, or if a new low-cost generic version of a brand-name product became available.
The Bush administration issued the policy with less than three weeks remaining before the May 15 deadline for people to sign up for Medicare drug coverage.