The federal government on Friday unveiled lists of providers for its prescription drug coverage program — a major step in an ambitious plan to make prescription drugs available to all Medicare beneficiaries.
In Utah, 18 organizations will offer stand-alone prescription drug plans, including two with monthly premiums less than $20. Five other organizations will offer the more comprehensive Medicare Advantage plan, and two of those will have at least one plan with no additional drug premiums.
Details of the plans will not be available until Oct. 1, when the organizations are allowed to start marketing to Medicare beneficiaries.
"This is historic development in bringing Medicare's coverage up to date," said Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services (CMS).
The prescription drug plan, commonly called Medicare Part D, is part of the Medicare Modernization Act of 2003. The legislation added what McClellan on Friday called "the most important new Medicare benefit in 40 years" — prescription drug coverage for some 43 million elderly and disabled Americans.
"Everyone in Medicare will be able to choose a drug plan that addresses their needs and costs," he said. "Seniors will be able to get coverage that helps protect their health as well as their savings."
The benefit plan is available to all recipients of Medicare, a federal insurance plan for disabled Americans as well as those 65 and older. Some recipients of Medicaid, a joint federal and state program for low-income individuals, will also qualify for the program.
Benefits are scheduled to begin Jan. 1, although at least one federal lawmaker has called for a halt to the estimated $700 billion program. Earlier this week, Senate Majority Leader Trent Lott said he regretted voting for the program and suggested the money would best be used to aid rebuilding efforts in areas devastated by Hurricane Katrina.
Michael Fierberg, with CMS public affairs, said the comments have had no impact on plans to roll out the program.
"We're moving ahead, that's all I can tell you at this point," he said. "We're expecting to move forward with this plan and bring it forward on schedule. If Congress, in its infinite wisdom, decides to change that, we'll change that."
On Friday, McClellan encouraged all eligible beneficiaries to use this time to begin evaluating their prescription drug needs in three areas — cost, coverage and convenience. That way, he said, people will be ready to choose a plan when enrollment begins Nov. 15.
"It's time to start thinking about what matters for you for the drug coverage," McClellan said. "It's not quite time yet to make a decision."
Because of the complexity of the new plan, outreach efforts have been undertaken all over the country to educate eligible participants about the program. In Salt Lake County, representatives from Aging Services have spent the past two months visiting senior communities, sometimes going door to door, explaining the upcoming changes and meeting individually with eligible recipients.
"It really is a matter of getting to this one-on-one individual to explain the program and to explain the benefit," said outreach program manager Peter Hebertson. "Because the seniors we're encountering really don't understand how important this is."
The agency focused primarily on low-income seniors who now get their prescription drugs through Medicaid and whose coverage will be transferred to Medicare under the new program. These so-called "dual eligibles" will be randomly assigned to a plan if they do not select one of their own prior to Jan. 1.
"We really have to be salesmen, and we really have to convince them that this is important and you really do need to look at this and make an educated choice," Hebertson said.
In Riverton recently, residents at a senior apartment complex had a chance to sit down with Hebertson and his staff to determine their specific prescription drug needs. Many came armed with bottles of pills, financial statements and questions about the new program.
With a monthly income of $904, one woman learned she qualified for the low-income subsidy, meaning she'll likely have no deductible and $3 and $5 co-pays at the pharmacy.
"You're exactly who this program was designed to help," Hebertson told the woman. "That is why we've got to get ahold of you in the fall so you can choose the best plan for you."
At each stop, Aging Services collected names and phone numbers so they could call the beneficiaries after the specific plans are released next month and offer additional personalized assistance.
"I appreciate them coming and working with us, because it's going to be confusing," said Riverton resident Sandra West.
With so much information out there, it's tough even to know whom to turn to for help, she said.
In the coming months, McClellan said, there will be many resources for beneficiaries to seek help selecting a plan. In mid-October, CMS will launch a prescription drug plan finder on its Web site, www.medicare.gov, or through its hotline, 1-800-MEDICARE.
Local health departments and agencies that work with seniors are also valuable resources, he said.