"Many older Americans choose managed care specifically for prescription drug coverage," Grassley said. "They seek a benefit that traditional Medicare doesn't offer. They want coverage of the prescription drugs that work for them. However, managed care plans often change the specific drugs they cover as part of their business. It's important that seniors know of this possibility before they sign up for managed care. No one should be in for an unpleasant surprise at the drugstore."
Grassley's comments came after an Aging Committee hearing, "Drugstore Surprise: the Impact of Drug Switching on Older Americans." The Committee released a General Accounting Office report showing that 16 managed care plans participating in Medicare vary greatly in the way they cover prescription drugs and in their methods of informing beneficiaries of potential changes.
According to the report, some of the plans notify seniors in writing when they intend to stop covering a certain drug. Other plans provide no advance notice, likely resulting in some seniors learning of changes from their pharmacists. The plans covered in the report represent more than 25 percent of all Medicare beneficiaries enrolled in managed care.
A 77-year-old hearing witness, Mary Jane Lathrop of Antelope, Calif., said she joined a managed care plan after learning that it covered her blood pressure medication. She testified that her pharmacist later notified her when her health plan dropped coverage of the drug. Surprised and disturbed, she received a prescription for another drug, which she said increased her blood pressure.
Grassley said he will work to ensure full disclosure of changes in drug coverage by Medicare managed care plans. Grassley and Sen. John Breaux, ranking member of the Committee, plan to request in writing that the Health Care Financing Administration (HCFA) develop a plan of action to address the disclosure problems highlighted at today's hearing.
Grassley and Breaux will urge HCFA to survey the participating plans to gather records on their policies regarding their drug benefit, then determine how to communicate those policies to the beneficiaries. "Older Americans should know what they're getting with managed care plans," Grassley said. "It's like a buying a car. Before you buy, you expect to know all of your options. If prescription drug coverage is part of a benefit package, seniors should know the extent of that coverage before they sign on the dotted line."
Grassley, Breaux and Sen. Ron Wyden requested the GAO report.