Apr 3, 2006- Kaptur Issues Letter to HHS Secretary Leavitt

April 3, 2006

The HonorableMichael Leavitt, Secretary
U.S.Department of Health & Human Services
200 Independence Avenue SW
Washington, DC 20201

Dear SecretaryLeavitt:

Thank you forcoming to our region to view first hand the implementation of the BushAdministration's Part D drug plan for people on Medicare. Taking the timeto listen to people's concerns and working with Congress to achieve legislativeand regulatory remedies to address the program's shortcomings can benefitAmericans.

ReduceCosts Through Bulk Purchasing Agreements

Importantly, Iurge you to join Members of Congress in supporting legislation to allow theCenters for Medicare and Medicaid Services to negotiate purchase price ofpharmaceuticals and allow bulk purchase agreements to hold down prices toconsumers. The rising costs of pharmaceuticals to consumers since thepassage of this law demonstrates that much more must be done to achieveaffordable prescription drugs for beneficiaries while controlling federalspending.

StandardizePlans

Until laws areable to be changed to provide an affordable, predictable Medicare Part D Rxbenefit for all people who are eligible, streamline the confusing array ofprivate plans by limiting their total number to ten, as we have accomplishedwith Medicare supplementary plans, this would greatly aid those trying todetermine which PDP is best for them.

Ban Gifts

As you know,eight million people who were deemed as "dual eligible" and enrolled inboth Medicare and Medicaid were required to sign up before January 1,2006. They, along with people enrolled in a Medicare Advantage plan orwhose employer-sponsored plan ceased coverage, comprise the bulk of people whohave signed up. This most vulnerable group of people continues to havedifficulty with plans in which they were enrolled and are prey to confusingsolicitations from the private drug plan operators. Please let me suggestHHS should develop regulations limiting the way in which these companies cansolicit. Full and clear disclosure should be required of what sign up inthe PDP will mean for that individual. Such lures as taking people out todinner, coming to their home, and gifts should be prohibited. Perhapsrules could be established like those put in place for Medicare supplementalinsurance coverage solicitation.

ExtendDeadline

Given theconsiderable difficulties people have had in trying to learn the details of theplan and the lack of information provided about the PDPs for which they mightsign up, extending the deadline to sign up without penalty would help ensurethat people to not rush to choose a PDP before the agency works out all of theprogram's problems.

DiscloseCoverage Gaps in PDPs

Companieswhich do not offer gap coverage, such as AARP, should be required to make thisfact very clear in writing. It should be clearly and simply stated whatdrugs are covered, what dosages of the drugs are covered, what is the true costto the consumer, and whether the full cost of the drug or the consumer's out ofpocket expense is the figure used in reaching the $2,250. It should alsobe stated clearly and boldly that the PDP may drop a drug from coverage, theterms under which the drug will be dropped, and what options exist for theconsumer if the drug is dropped. Our office is already hearing frompeople who are nearing their $2,250 because the full cost of the drug is usedthough this fact was never explained to them. We are also hearing frompeople already getting letters-three months into the program-that drugs arebeing dropped, and these PDPs are not giving a sixty day notice.

RequireUniform ID Numbers

Many of theproblems people have been experiencing when going to a pharmacy are the resultof a multiplicity of ID numbers. There is no uniformity or conformity ofa number the PDPs are using. Requiring all PDPs to use a person'sMedicare ID number would be helpful. This requirement simplifies trackingfor the pharmacist, ensures the enrollee knows the number, and makes it clearwhich number on the PDP card is the ID number. It also simplifiesenrollment verification for SSA and Medicare.

SimplifyApplication

Therecontinues to be a disconnect between agencies and PDP companies. SSA,Medicare, and state and county public assistance agencies need to be interconnectedwith each other and with the PDP companies through the use of one centralapplication. Related to this problem is the flow of information betweenMedicare, SSA and county public assistance agencies which results in confusionabout the program itself and subsidies to which people may be entitled. Perhaps the greatest barrier to people who are dual eligibles successfullytransitioning to the PDPs is this lack of coordinated information. Wewould ask HHS to take a vested interest in ensuring the interconnectedness ofall agencies involved and ensure that it occurs.

ExpandExtra Help Eligibility

The othergroup of vulnerable people requiring attention are those whose income qualifiesthem for Extra Help but whose other resources disqualify them. Youmay know that 4.5 million people have -applied for Extra Help but only 1.5million have qualified. HHS' own figures estimated that five millionpeople were eligible for Extra Help. Generally, people whose incomesqualify them do not have much more than the assets allowed and if they do,these assets are not very liquid. Thus, a more realistic resource testshould be developed. An alternative to be considered could be along thelines of the community spouse resource test used when one partner of a coupleenrolls in Medicaid while in long term care. Or guidelines could bedeveloped more in line with real-life expectations of the financial cushionspeople try to keep in place in the event of a catastrophic illness, death of aspouse, or protection against income reductions in older age.

RequireComparison of PDP To Existing Health Plan

People whohave good existing drug coverage are being told they can sign up for a PDP andstill retain their existing health benefits, such as people in the public employeeretirement system and unions or employer-sponsored plans. As a result,people are signing up for a PDP and then losing their full healthcoverage. We would appreciate a written explanation from HHS as to howthe PDP benefits interact with existing health coverage, and the consequencesto that health coverage of signing up for a PDP.

BroadenFormularies of PDPs

You havereplied to the issue of formularies in response to a previous inquiry fromme. I will ask again that this issue be examined so that the PDPs offerbroader formularies and do not restrict based on the dosage of amedicine. Particularly in the area of mental illness treatment, peopleare being forced to go without the vital medicine they can no longerafford. While Medicaid will assist those who are dual eligibles, thosewho are not-such as people enrolled in a Medicare Advantage plan-find they mustpay the full cost of their medicine or go without. For most it is nochoice, and they are forced to go without.

ExpandResources To Counseling Agencies

Finally, andimportantly, agencies providing counseling to people trying to understand theprogram must be appropriately supported. Already stretched budgets arestretched beyond capacity as these agencies help people. In our own region,the Area Office on Aging and the Ability Center of Greater Toledo have fieldedinquiries and spent two hours per person for thousands of people. Thisburden must be properly compensated by HHS.

Thank you foryour attention to these issues. I look forward to your reply, which Iwill share with our community and the agencies serving people on Medicare.

Sincerely,
Marcy Kaptur
U.S. Representative