Medicare drug benefit changes worry advocates

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Professionals who care for the estimated 6.3 million Americans who are eligible for both the federal Medicare and federal-state Medicaid health programs say patients could face significant disruption—and potential ill effects—when their drug coverage is switched from one program to the other at the end of this year.

Currently, Medicaid pays for the drug needs of the population known as “dual eligibles.” But starting Jan. 1, 2006, all of those individuals will have to be enrolled in new drug plans under the Medicare program.

"I don’t know how Oregon will successfully do this in this timeframe,” Dr. Tina Kitchin, Medical Director of Oregon’s Department of Human Services, told the U.S. Senate Special Committee on Aging.

Kitchin said the state spent a full year moving its Medicaid population into managed care programs in the 1990s, but under the current rules, will only have several weeks to make the coming transition.

A key problem, she said, is that many of those eligible for both programs will be unable to use the Internet or Medicare’s toll-free information lines to figure out which plan will work best for them.

A high proportion of those who will have to make the transition from Medicaid to Medicare drug coverage “have cognitive impairments, ranging from developmental disabilities and psychiatric illnesses to dementia, which not only make these choices almost impossible, but also make those tools irrelevant,” she said.

Dr. Carl Clark, CEO of the Mental Health Center of Denver in Colorado, said that even a brief interruption in medications can cause serious problems.

For mentally ill patients, he said, “a very large percentage of patients forced to switch medications will fail. Typically, this means rapid de-compensation into psychiatric crisis.” And those patients who fail to successfully make the transition, he said, “could end up destitute, homeless, or in state prison.”

Wendy Gerlach of Roeschen’s Omnicare Pharmacy, which provides medications to institutionalized patients, said the transition of patients from a single payer—a state Medicaid program—to possibly several different Medicare plans presents special problems for long-term care pharmacies. “The resulting confusion could increase the risk of medication errors,” she said.

Medicare and Medicaid Administrator Mark McClellan told the committee that the federal government has worked hard to ensure that no patient is disadvantaged by the move from Medicaid to Medicare drug coverage. “There will be no change in drug safety and no change in drug availability for this fragile population,” he said.

But Clark and Kitchin said McClellan’s assurances that the new Medicare plans will have to have “transition policies” to protect patients whose Medicaid-covered drugs are not on their approved lists, did not satisfy them.

In Oregon, many managed care plans do more than required, said Kitchin, but “we also have plans where it’s a struggle to get them to do the minimal,” and she expects the same range from Medicare drug plans.

Medicare officials “have stated that dual eligibles with severe mental illnesses who are randomly assigned to plans that don’t reflect their current medication regimens can re-enroll into [plans] that do,” said Clark. “Based upon my years of clinical experience with this population, I have very serious doubts about this approach.”

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