An extension of the May 15 enrollment deadline for the Medicare prescription drug benefit is "legally not permissible," CMS Deputy Administrator Leslie Norwalk said on Friday, the AP/St. Paul Pioneer Press reports. The 2003 Medicare law states that a "special enrollment period" beyond the deadline can be established only for beneficiaries with exceptional circumstances (Freking, AP/St. Paul Pioneer Press, 4/14). CMS earlier this month announced that it will allow "ongoing" enrollment in the Medicare prescription drug benefit for beneficiaries who qualify for a low-income subsidy (Kaiser Daily Health Policy Report, 4/14). Democratic lawmakers and some advocacy groups have been pressing the Bush administration to extend the deadline for all Medicare beneficiaries. Rep. Rahm Emanuel (D-Ill.) said, "If a delay in the enrollment deadline is good enough for low-income seniors, it is good enough for all seniors -- regardless of income." The Medicare Rights Center urged HHS Secretary Mike Leavitt to extend the deadline for all beneficiaries because many are "paralyzed by the array of confusing private drug plan choices." However, Norwalk said giving an extension to all 43 million eligible beneficiaries would "undermin[e] what Congress put into place." She added, "Our actuaries tell us 1.6 million fewer people would enroll if we do that. We are not going to push back the deadline." Norwalk also said the deadline encourages people with relatively few drug expenses to enroll, allowing for lower overall costs. Meanwhile, CMS spokesperson Peter Ashkenaz said beneficiaries who are not sure if they qualify for the low-income extension should enroll before the deadline (AP/St. Paul Pioneer Press, 4/14).

Basic Plan Costs To Increase
In related news, CMS last week announced that deductibles, coverage limits and out-of-pocket expenses for basic Medicare prescription drug coverage will increase by nearly 7% in 2007, the Wichita Eagle reports. Standard plan deductibles will increase from $250 to $265, coverage limitations will increase from $2,250 to $2,400 and maximum out-of-pocket costs will increase from $3,600 to $3,850. CMS officials said the increases are required under the 2003 Medicare law and will not have a great impact on most beneficiaries. "More than 90% of beneficiaries are not in a plan with a standard benefit," Ashkenaz said, adding, "In most cases, they are in plans that have zero or no deductibles and with low copays for covered drugs" (Atwater, Wichita Eagle, 4/15).

Patient Assistance Programs
Senate Finance Committee Chair Chuck Grassley (R-Iowa) and Sens. Max Baucus (D-Mont.), Orrin Hatch (R-Utah) and John Rockefeller (D-W.Va.) on Monday sent a letter to HHS Inspector General Daniel Levinson asking him to clarify how the Medicare prescription drug benefit will affect pharmaceutical companies' patient assistance programs, CQ HealthBeat reports. Some pharmaceutical companies have said they will end their patient assistance programs on May 15 because they are concerned that the programs could violate federal anti-kickback laws that prohibit drug makers from steering beneficiaries toward their own products. In January, the Pharmaceutical Research and Manufacturers of America cited a guidance document from the inspector general as the reason for ending the programs. In the document, Levinson said that drug makers can lawfully provide assistance to low-income beneficiaries, in part by contributing to charities that administer the programs. In Monday's letter, the senators ask Levinson to issue a "prompt and definitive guidance" to assure pharmaceutical companies that the patient assistance programs can continue. The letters says that without such programs, "some Medicare beneficiaries may not otherwise be able to afford their prescription drugs, even if they are enrolled in the ... drug benefit." The letters asks that the clarification be issued "as expeditiously as possible" (CQ HealthBeat, 4/17).

Additional Coverage

• Los Angeles Times: The Times examines how some beneficiaries have found that Medicare drug plans' prices "are sometimes little better, and sometimes worse, than those offered at low-margin pharmacies," especially "[w]hen premiums, copayments, coverage gaps and other costs are figured in." Several small surveys have found that warehouse retailers, such as Costco, and online pharmacies, such as Drugstore.com, offer "better discounts overall" than Medicare drug plans, according to the Times. However, "[e]xperts say the program clearly can benefit chronically or catastrophically ill people who take many costly medications," the Times reports (Reitman, Los Angeles Times, 4/18).
  


• USA Today: USA Today examines how low-income beneficiaries and "those with few health problems" have been "the slowest to sign up" for the drug benefit. According to USA Today, beneficiaries who could qualify for a low-income subsidy "have been the hardest to enroll, often because of educational or language barriers." Healthy beneficiaries also have not enrolled in large numbers, mostly because many of them do not have high drug costs (Wolf, USA Today, 4/18).
  

Editorials, Opinions
Several editorials and opinion pieces and a letter to the editor recently addressed the Medicare prescription drug benefit. Summaries appear below.

• USA Today: A "long extension" of the deadline for enrolling in the drug benefit "would be a mistake" because "many" beneficiaries would then "be tempted to delay [enrollment] until they need expensive medicines," a USA Today editorial states. However, the editorial adds, "a short extension might be needed to cope with problems caused by a last-minute rush" (USA Today, 4/17).
  


• Brad Woodhouse, USA Today: The benefit "is so hopelessly flawed that the enrollment deadline ... must be extended to give Congress time to fix this debacle," Woodhouse, communications director for Americans United, writes in a USA Today opinion piece. Woodhouse concludes that Congress should use a deadline extension to make the benefit "simple, affordable and guaranteed" (Woodhouse, USA Today, 4/17).
  


• Washington Post: "At the time this drug benefit was rolled out, the leadership of [HHS] was eager to point out that the much-criticized private-sector involvement with the benefit was designed not to rip off seniors but to provide them with cheaper drugs over time," a Post editorial states. The editorial adds, "It is too early to say whether this process has begun to work," and "only when there have been several rounds of annual plan selections ... will it be possible to declare whether this artificially designed market has been a 'success' or a 'failure'" (Washington Post, 4/15).
  


• Rep. Pete Stark (D-Calif.), Washington Post: "The nonpartisan Congressional Budget Office ... determined that a one-time extension of the enrollment deadline would result in an additional 1.1 million sign-ups this year -- and lower premiums and late-enrollment penalties for 10 million more Medicare beneficiaries for the rest of their lives," Stark writes in a letter to the editor of the Post. Stark notes that a Post opinion poll found that 71% of seniors support an extension of the deadline and concludes that, "[r]ather than listening to the drug and insurance companies that oppose an extension, the president ought to hear seniors" (Stark, Washington Post, 4/17).
  


• Donald Lambro, Washington Times: Recent polls about the benefit "strongly sugges[t] that the early doom-and-gloom stories about the program's problems were premature," Lambro, chief political correspondent for the Times, writes in an opinion piece. He adds that the program's "market-oriented structure" needs "to be broadened and improved in the legislative fine-tuning that will no doubt be done in the years to come" (Lambro, Washington Times, 4/17).