Understanding Changes in Prescription Drug Coverage for People with Disabilities on Medicare

A project of Advancing Independence • November 2005

Jeffrey S. Crowley, Health Policy Institute, Georgetown University
with Bob Williams, Advancing Independence

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Action Steps for Disability Organizations

The Medicare Part D program is complicated…and it is probably not the main focus of your organization. Nonetheless, whatever the level of available resources, do what you can. The worst thing that disability organizations could do would be to decide the law is too complex—and thus, do nothing.

As with recommendations for individual Medicare beneficiaries with disabilities, we have sought to simplify the actions that disability organization could do—to spur you to action. We encourage all disability services providers and disability advocacy organizations to:

Train frontline staff who work directly with clients/members;

  1. Conduct community forums and educational programs for clients/members;
  2. Identify community resources for assisting with educational efforts and/or supplementing Part D coverage;
  3. Provide one-on-one counseling, if practical; and,
  4. Monitor the experience of Medicare beneficiaries with disabilities.

1. Train frontline staff who work directly with clients/members

The federal Centers for Medicare and Medicaid Services (CMS) has devoted significant resources to help ensure that Medicare beneficiaries understand how to access prescription drugs through the Part D program. This includes several training opportunities for community-based organizations. Additionally, most of the national disability advocacy organizations have developed programs to train their members on the Part D program. Contact these organizations and request information and seek out training opportunities.

A number of organizations have also teamed up with federal officials to conduct outreach on the Part D program. The Access to Benefits Coalition has developed multiple resources that may be helpful to disability organizations. To learn more, go to http://www.accesstobenefits.org/.

2. Conduct community forums and educational programs for clients/members

Do not become intimidated about being an expert on all of the details of the prescription drug program. In the absence of your organization preparing for the transition to Part D coverage, dual eligibles will have their Medicaid drug coverage end, and other Medicare beneficiaries will still have to select a plan. Your involvement can only help individuals to make more informed decisions. As with trainings for frontline staff, federal resources and national organizations may be available to assist with training and outreach.

3. Identify community resources for assisting with educational efforts and/or supplementing Part D coverage

As discussed earlier, states, Area Agencies on Aging, state pharmacy assistance programs, pharmaceutical patient assistance programs, churches and religious organizations and charities may be available to provide resources to assist organizations in conducting education and outreach—and to support individuals by providing supplementary financial assistance. An important role for community-based organizations is to assess which community resources exist and determine if such resources are planning to provide assistance to people with disabilities.

State Health Insurance Counseling and Assistance Programs (SHIPs) are federally funded programs operating in every state to assist Medicare beneficiaries. They are available to educate Medicare beneficiaries about Medigap supplemental insurance options, Medicare private plan options, procedures for appealing pre- or post-service denials, and low-income assistance programs. With the establishment of the Part D program, they also have an important role to play in assisting Medicare beneficiaries. To find the SHIP program in an individual state, go to: Link or call 1-800-MEDICARE (1-800-633-4227). For people who are deaf or hard of hearing, the toll-free TTY line is 1-877-486-2048.

4. Provide one-on-one counseling, if practical

Despite the best efforts of many people and organizations to simplify the Part D program and to explain the range of options available to individuals, the system is too complicated for many individuals to navigate on their own. To the extent that it is feasible, disability organizations should seek to provide one-on-one counseling—or link individuals to such assistance if this support is available elsewhere.

As part of this effort or as a substitute for one-on-one assistance, organizations should develop sample plan comparisons. For example, an organization that works with people with a specific type of disability could develop a “typical” drug regimen, and use this to compare the plans available in the region. Or, it may be known that many people rely on one particular pharmacy. Therefore, a plan comparison could look at which plans provide access to a particular pharmacy. This could be especially important for residents of nursing home or other long-term care facilities.

5. Monitor the experience of Medicare beneficiaries with disabilities

As of January 1, Medicare drug coverage will begin. But, this is the beginning, not the end of the story. Unforeseen issues will arise, and many problems will be resolved. To make future improvements to the Medicare Part D program possible, it will be important to gather evidence of both the successes and challenges experienced by Part D plans in meeting the needs of Medicare beneficiaries with disabilities. Disability organizations have an important role to play in tracking the experience of people trying to access prescription drug coverage.

Do people with disabilities have a positive experience in a certain plan? Are there problems getting plans to approve coverage for a specific drug? Are there accessibility issues that arise?

In addition to individual stories (which are very helpful), organizations should consider developing a survey of their members/clients after some initial period (such as 6 months after the Part D program starts). Organizations should also be creative in thinking of other ways that they can collect information to shed light on how the Part D program is working from the perspective of people with disabilities.

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This consumer guide was developed with financial support from the Pharmaceutical Research and Manufacturers of America (PhRMA). Copyright © 2005 by Advancing Independence. Permission to duplicate is granted and encouraged. Please acknowledge the source. Please direct questions to robert.willliams@gmail.com.