Navigating Medicare's ups, downs
Since Jan. 1 , some 38.2 million Americans signed up for Medicare's new prescription drug plan, known as Part D . Dr. Mark B. McClellan , the Centers for Medicare and Medicaid Services administrator , recently spoke with Globe reporter Diedtra Henderson about Part D's ups, down, and future -- as well as his.
Q: The critics are harsh. To describe Part D's implementation, they use words like `turmoil,' a `dizzying' array of plans, `confusing' drug formularies. But you call it a `fiscal success story.' Please explain.
A: The costs are much lower than had been projected and, also, the satisfaction of beneficiaries in the program continues to look very good. Recent independent polls show beneficiaries have an 80 percent-plus satisfaction rate with the program. And beneficiaries -- when asked if they would prefer the same plan they're in or switch to another one, knowing what they know now six months into the program -- by more than a 7-to-1 margin say that they like the plan they're in now.
Q: This summer, seniors are encountering the `doughnut hole,' a coverage gap that shifts their payments from just a co-pay to the drug's full price. Democrats, including House Minority Leader Nancy Pelosi , say Medicare should be permitted to aggressively negotiate for lower prescription drug prices and apply savings to the doughnut hole.
A: The drug plans are aggressively negotiating. UnitedHealthcare , Humana, and others collectively cover tens of millions of beneficiaries and they are using that negotiating clout to get prices down. That's one reason the costs have turned out to be so much lower than expected. Ninety percent of seniors are enrolled in drug coverage and have the option of getting comprehensive coverage that fills in the doughnut hole.
Q: What do you make of Representative Pelosi's change of heart on Part D?
A: The benefits are proving to be quite popular with beneficiaries. It was a new program that required seniors to make a choice. And I talked to many seniors, including up in Boston, and that process could be daunting and frustrating. But there were many places to go for help. And seniors have worked through it.
As critics of the program are seeing that experience, they are moving away from calling for the program to be repealed or stopped, and actually calling for more choices to be added.
Q: But there will be fewer choices in the future, right?
A: I think so. The plans were required by us to only offer bids this year that had to meet several standards. One was clear differentiation from other bids that were being offered by the organization. And the second was clear evidence that they would be popular with beneficiaries. In addition, we allowed plans to offer a third option, if they filled in the doughnut hole.
Q: Part D has been the defining issue of your CMS tenure. Here's your chance to write history. In 10 years, what will consumers say about Part D?
A: Ten years from now, my goal is to make sure that Medicare has not fallen behind again. We were in a situation -- where the benefits by the government had gotten way of out date with the healthcare needs of seniors and with the healthcare capabilities of modern medicine.
This year, we are expanding the support that we are providing to help people not only to choose a drug plan but to choose other aspects of their coverage. We're going to have comparative information on Medicare Advantage health plans, which are widely available in Massachusetts, and on Medigap plans.
And we're also going to start providing, this year, information on use of benefits.
For example, for preventive benefits, if you're eligible for screening for cancer or heart disease or diabetes, we're going to tell you about that, too.
This kind of partnership needs to be a permanent part of Medicare and hopefully will be established as a permanent part of Medicare 10 years from now.
Q: You made it sound as if you'll be at CMS in 10 years, but there's speculation that suggests otherwise.
A: We've got a lot of work that we're busy with now for getting better coverage options in place for next year, for building on and learning from our experience this year. I'm definitely keeping busy.
