Easing the Part D Transition: An Evaluation of Federal and State Efforts to Ensure Dual Eligibles and Other Low-Income Beneficiaries Maintain Prescription Drug Coverage; Final rept

摘要

Leading up to the implementation of Medicare Part D in January 2006, the Centers for Medicare & Medicaid Services (CMS) anticipated problems transitioning drug coverage for dual eligible beneficiaries from Medicaid to Medicare. To forestall these problems, CMS expanded its Part D contract with WellPoint (Anthem), a national prescription drug plan (PDP) with a Part D plan premium at or below the low-income premium subsidy amount in all 34 PDP regions across the United States, to provide temporary drug coverage at the pharmacy counter for those full-benefit dual eligible beneficiaries who were eligible for but not yet enrolled in a Part D prescription drug plan. This contract, called the 'Point-of-Sale Facilitated Enrollment' (POS FE) process, was later modified to cover not only full-benefit dual eligible beneficiaries, but also partial-benefit dual eligible beneficiaries (or Medicare Savings Program beneficiaries), supplemental security income (SSI) cash assistance recipients with no Medicaid (SSI-only), and beneficiaries who applied for, and were awarded the Part D low-income subsidy (LIS applicants). CMS also exercised its waiver demonstration authority in early January 2006 in response to temporary action taken by states to provide emergency drug coverage for dual eligibles and other low-income beneficiaries no longer receiving coverage through state Medicaid programs.