Rep. Courtney Introduces Medicare Part D ‘Fix'

Press Release

Rep. Courtney Introduces Medicare Part D ‘Fix'
Congressman Addresses Critical Faults of Prescription Drug Program

Representative Joe Courtney announced today that he has introduced legislation in Congress to improve the Medicare Part D Prescription Drug Program.

Congressmen Joe Courtney and Chris Murphy joined for a press conference two weeks ago in Hartford to announce their intent to introduce two pieces of legislation to improve the benefit, and today the legislation has officially been offered in the House of Representatives.

"Connecticut's senior citizens have waited far too long for an improved Medicare Part D prescription drug program and for some this issue truly is a matter of life and death," stated Courtney. "I am proud to introduce this legislation on behalf of America's senior citizens who should not be forced to contend with indefensible penalties or gaps in coverage."

Congressman Joe Courtney's legislation includes the following provisions to improve the quality of coverage Connecticut's senior citizens receive:

Narrowing the Gap in Coverage - The notorious ‘donut hole' forces Medicare Part D participants to pay 100 percent of prescription drug costs out-of-pocket after they reach a certain threshold of coverage. This provision allows certain third-party expenditures to count towards beneficiaries' out-of-pocket payments, including: state pharmaceutical assistance programs, Indian health services, federally qualified health centers, AIDS drug assistance programs, and disproportionate share hospitals and pharmaceutical manufacturer patient assistance programs.

By permitting these costs to count towards the ‘donut hole' lower and middle-income seniors will need to worry less about how they will afford life saving medications.

This provision also requires the Department of Health and Human Services to study methods to pay for the complete elimination of the ‘donut hole'. The study must be completed within 180 days of enactment of the bill.

Ending Late Enrollment Penalties - The current Medicare Part D program inflicts lifetime penalties on senior citizens. Congressman Courtney's legislation removes penalties incurred by seniors from the program's inception through January 1, 2008.

The bill also changes the late enrollment penalty to match Medicare Part B, which is 10% of the base beneficiary premium for each 12 consecutive month period.

Current law allows for the Secretary to waive penalties if misinformation is given to the individual. This bill will put the burden on HHS to prove that the individual was given correct information, rather than an individual needing to prove that the information provided was false.

This provision is a result of a 2006 GAO study that found that a significant number of Medicare enrollees who called the 1-800-MEDICARE helpline were provided incorrect or incomplete information.

Flexibility in Plan Enrollment - Currently, prescription drug program providers are able to change their formulary at any time during the one-year enrollment period without notice. However, while providers can change their programs or benefits, seniors are not permitted to change programs for one year.

This provision allows an individual enrolled in a prescription drug plan to change their plan as often as the Secretary permits the plan to change its formulary. The provision allows the individual to change plan during the first three months of each year (open enrollment) such as is allowed under Medicare Advantage.

Low Income Subsidy Improvements - This provision removes the asset test for low income subsidy. The bill also waives all late enrollment penalties for individuals eligible for the subsidy.

Source