Senator Carper Expresses Concern Over Medicare Website

WASHINGTON, DC (October 24, 2005) – Senator Tom Carper (D-Del.) today sent a letter to the Center for Medicare and Medicaid Services saying Medicare’s new website, designed to help seniors make decisions about the new prescription drug benefit scheduled to go into effect on January 1st, is incomplete and inadequate. The letter states that Medicare’s new on-line “Prescription Drug Plan Finder” fails to help seniors locate the information they need to decide which drug plan, available through the new Part D benefit, best suits their needs. “As it stands, the website does not provide adequate information for beneficiaries to make informed decisions about what plan would be best for their needs or what level of out-of-pocket spending they might incur under any given plan,” the letter states. According to the letter, the new Plan Finder: Does not allow users to enter the medications they currently take in order to find out which plans cover those medications; Does not include clear information about how much seniors would have to pay for their medications; Does not include clear information about other “out-of-pocket” costs. The letter notes that Medicare-eligible Delawareans will need to choose one plan that best meets their specific needs. It is therefore vital that beneficiaries have access to individualized help that can be customized for each beneficiary. Carper said Medicare should simplify and complete the website as soon as possible. Beneficiaries should be able to enter where they live, the medicines they take, and their preferred pharmacy and should then be given concise, easy-to-understand information as to which plans cover their medications, the dollar amounts of any co-payments or cost-sharing, the size and structure of any coverage gap, and which pharmacies they may use under the plan. The full text of the letter follows: October 24, 2005 Administrator Mark McClellan, M.D., Ph.D. Centers for Medicare and Medicaid Services 200 Independence Ave., SW, #314-G Washington, DC 20201 Dear Dr. McClellan: I wrote to you recently regarding my concerns with the 1-800-MEDICARE helpline and whether it will meet beneficiaries’ needs during implementation of the Medicare prescription drug benefit. Tools like the helpline will be a vital part of providing one-on-one assistance to seniors and disabled persons to give them information about the new drug benefit and to help them select a drug plan that meets their individual needs. Personalized, individual assistance is one of the most valuable services that we can provide as we approach and enter the enrollment period. Complicating the enrollment process is the fact that as we proceed, Medicare beneficiaries will be inundated with information. Prescription drug plans began marketing their plans in early October. According to CMS regulations, plans may send beneficiaries information by mail, call them at home, and are also allowed to advertise on television, radio, and in newspapers. Yet beneficiaries will be faced with the task of sorting through the many different plan options – over 60 in Delaware from 19 prescription drug sponsors and 4 Medicare Advantage sponsors – and will need to choose one plan that best meets their specific needs. It is therefore vital that beneficiaries have access to individualized help that can be customized for each beneficiary. I am therefore concerned that CMS last week posted the Medicare Prescription Drug Plan Finder in incomplete form. My staff tested the tool and had great difficulty navigating it. First, the Plan Finder does not yet allow the user to enter the medications that he or she takes in order to find out which plans cover those medications. When my staff tried to use the “Medication Entry” tool that in theory will tell beneficiaries which plans cover their drugs and how much the drugs will cost, a screen appeared noting that this feature was not yet available. My staff was eventually able to find some formulary information, but cost-sharing information was not available for some plans, and for other plans, the cost-sharing and tiering structure was not easily decipherable. My staff also was unable to find specific information regarding the size of the coverage gap or “donut hole” in the plans. Beneficiaries must know the size and format of any gap in coverage in order to properly evaluate a plan. Finally, the page entitled “Review Plan Results & Options” which lists the available plans in an area, was confusing. This page included a column labeled “Coverage Gap”. A “No” in the “Coverage Gap” column, instead of meaning “no coverage gap”, means that there IS a coverage gap. A footnote at the bottom explains the meaning, but seniors should not have to sift through footnotes in order to understand this. The Medicare website notes that “Once the Medicare Prescription Drug Plan finder is fully operational, it will allow people with Medicare to personalize their search for a drug plan, and look at a side-by-side, personalized comparison of up to three plans at a time so they can find one that meets their needs.” However, when my staff contacted CMS, they were unable to provide a timeline for when the Plan Finder would be operational. The Plan Finder should have been fully operational when it was launched earlier this week. Posting of an incomplete or inadequate tool will likely frustrate beneficiaries and add to confusion. Our goal should be to simplify the website as much as possible. Beneficiaries should be able to enter their area of residence, the medicines they take, and their preferred pharmacy. They should then be given concise, easy-to-understand information as to which plans cover their medications, the dollar amounts of any co-payments or cost-sharing, the size and structure of any coverage gap, and which pharmacies they may use under the plan. I encourage CMS to complete the Plan Finder tool as soon as possible in order to allow beneficiaries and their families to investigate plans. As it stands, the website does not provide adequate information for beneficiaries to make an informed decision about what plan would be best for their needs or what level of out-of-pocket spending they might incur under any given plan. I would greatly appreciate a response regarding the steps you plan to take to simplify and complete the Plan Finder tool. These steps should be taken immediately to ensure that beneficiaries and their families have sufficient time to evaluate their options. I appreciate your attention and assistance in this matter and look forward to hearing from you. With best personal regards, I am, Sincerely yours, Senator Tom Carper