Medicare Agency Adds Drug Plan Safeguards (AP)

By KEVIN FREKING, Associated Press Writer

WASHINGTON - The agency overseeing the Medicare drug benefit has issued new guidelines to insurers to protect enrollees from abrupt changes to their prescription plans.

Under the Medicare program, insurers can change their formulary after getting approval from the government and after providing 60 days' notice to individuals taking the drugs. Some lawmakers and advocacy groups had voiced concerns that such changes could potentially leave beneficiaries without access to needed medications.

The Centers for Medicare and Medicaid Services (CMS) addressed those concerns in guidance sent Thursday to the insurers. Current enrollees in a plan must be exempted from the formulary changes for the remainder of their plan's year.

"Under Part D, no beneficiaries will be subject to a discontinuation or reduction in coverage of the drugs they are currently using, except for clear scientific and cost reasons," said Abby Block, a CMS official.

Rep. Pete Stark, D-Calif., described the change as "better late than never."

"I hope this is the first of many actions to fix the myriad of problems with the confusing Republican drug program," he said.

The trade association representing the insurance industry, America's Health Insurance Plans, also endorsed the proposal. Plan sponsors may need to make formulary changes during the year to provide Medicare beneficiaries with a prescription drug benefit that reflects the latest in scientific evidence, the board members said in a statement.

"At the same time, AHIP members strongly support maintaining continuity of care if a formulary change is made," they said.

The board members said that changes for existing enrollees are justified under the two exceptions cited by CMS: when safety concerns have been identified and when a generic alternative to a brand name becomes available.

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Official Medicare site: http://www.medicare.gov