States' Issues and Concerns with Implementation of Medicare Part D Prescription , Drug Coverage

States Issues and Concerns with Implementation of Medicare Part D 
Prescription Drug Coverage 
 

Summary of an Audioconference with States 
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (M MA) represents the most significant change to the Medicare program since its inception in 1965. The new Medicare pharmacy benefit, which will provide drug coverage for many individuals that previously had none, also has broad implications for states. In particular, the MMA requires state Medicaid programs to determine eligibility for new groups of low-income Medicare beneficiaries, and contribute to the cost of federal prescription drug coverage for individuals covered by both Medicare and Medicaid (dual-eligibles). In addition, the law has implications for states that currently have state pharmacy assistance programs (SPAPs) for low-income elderly.

 
To identify state technical assistance needs, the Rutgers Center for State Health Policy and State Coverage Initiatives (SCI) held an audioconference on May 10, 2004, with SPAP and Medicaid administrators to discuss issues of concern with implementation of the Medicare Part D prescription drug benefit. The issues identified on the call will be used to develop the agenda for an invitational meeting for SPAP and Medicaid officials to be held October 7-8 in Philadelphia. The meeting is sponsored by The Robert Wood Johnson Foundation (through SCI and the Center for Health Care Strategies), the federal Agency for Healthcare Research and Quality, and The Commonwealth Fund. 

States' represented on the call raised the following issues: 
While states with SPAPs are grappling in real time with how to coordinate existing state pharmacy programs with the Medicare-endorsed discount cards, most states are only beginning to think through the implementation issues and necessary work to effectively coordinate with the Part D Prescription Drug benefit, which begins January 1, 2006. The tasks necessary to implement Part D and effectively coordinate other state programs with the new benefit (Medicaid and SPAPs) seem daunting to states and they are frustrated by the slow pace of information from CMS on the details of the program and the short implementation timeframe. Concerns include: 1) deciding whether states should supplement Part D coverage and coordinating benefits; 2) determining eligibility; 3) assessing the impact of the changes on existing Medicaid pharmacy cost-containment strategies; and 4) obtaining needed research.