RespiteMatch.com Health Blog

By Julie Appleby and Richard Wolf, USA TODAY

WASHINGTON — Almost one-third of the 6.2 million Medicaid beneficiaries who were automatically switched to the new Medicare prescription drug program on Jan. 1 were put in plans that cover fewer drugs than commonly used under Medicaid, a new study shows.

Only 18% of those beneficiaries were assigned to plans that cover all of the 178 commonly used drugs, says a report from Daniel Levinson, inspector general for the Department of Health and Human Services.

The report comes as concern grows over the fate of those low-income Medicaid patients, who were automatically enrolled in Medicare’s prescription drug program at the start of the year. They lost their drug coverage through the state-administered Medicaid programs, which some advocates say was a better benefit.

Stephanie Altman, program and policy director for Health and Disability Advocates, a Chicago-based group that helps low-income people on Medicare and Medicaid, says the study illustrates one of the risks facing this population.

“You’re talking about people who already had a very robust benefit,” Altman said. “Those people stood to lose, and they did.”

But the Centers for Medicare and Medicaid Services, the agency that runs the new Medicare drug program, says the inspector general’s findings are misleading. The agency did its own study, which looked at individual beneficiary records to determine how many of their current drugs were covered by the new plans.

“We found that more than two-thirds of (beneficiaries) were assigned to plans that covered every single one of the drugs they were actually taking,” said spokesman Gary Karr. “Only 8.2% were assigned to plans that covered less than 70% of their drugs.”

Overall, he said, 93% of the drugs people used under Medicaid were covered under the Medicare plans. That percentage is similar to what the inspector general’s researchers found: an average of 92% of the 178 most common drugs were covered.

Karr also said that in cases where a drug is not covered, there is generally an alternative available. As an example, he cited hay fever drugs, for which there are several different brand and generic options.

Advocates such as Altman say the transition has not gone smoothly for thousands of former Medicaid patients. Many are considered particularly vulnerable because they are poor, sick and in some cases suffering from dementia, or have other problems communicating.

Problems included missing or unavailable enrollment information, leading some to be turned away from pharmacy counters. Others were charged deductibles and copayments from which they are supposed to be exempt. More than 20 states have established temporary assistance programs for their former Medicaid patients.

The inspector general’s report highlights what is expected to be an ongoing issue for many patients in the new drug program, and particularly those who were transferred from Medicaid: What will patients do when confronted with drug lists that don’t cover their medications, or require them to try less expensive drugs first?

Those rules, commonly found in commercial health plans for working-age Americans but less familiar to the elderly or disabled, mean patients must decide whether to switch to other plans, change their prescriptions or ask their doctors to appeal so they can keep their current medications.

“Given the medical and resource challenges faced by this population,” the inspector general’s report said, these low-income beneficiaries may need extra individual help they’re now not getting to handle the switch from Medicaid to Medicare.

The study found that in every region of the country, there is at least one Medicare drug plan that contains all of the commonly used drugs. Other findings include:

The percentage of commonly used drugs varied among plans, from a low of 76% to a high of 100%.

About half of the 178 commonly used drugs were included in all 37 formularies studied.

The most commonly omitted drugs were those that regulate blood pressure, cholesterol and pain.

States where people are most likely to be in plans that cover 85% or less of the 178 common drugs include California, Arizona, Nevada, New Mexico, Florida, New York, Connecticut, Massachusetts, Rhode Island and Vermont.