WASHINGTON WIRE

In this issue, you'll find:

• Drug Discount Card Program Goes Online Amid Beneficiary Confusion
• Partial Birth Abortion Ban Reversed
• PPSV’s Managing Partner to Lead Audio Conference on OIG Guidance on Discounts and Waivers
• Hearings

Top Story

Drug Discount Card Program Goes Online Amid Beneficiary Confusion

Tuesday June 1 marked the first day Medicare beneficiaries could begin using their prescription drug discount cards in pharmacies. The cards are expected to save beneficiaries anywhere from 10-20% off retail prices and be accessible at a wide range of pharmacies. But according to recent data on enrollment and several prominent studies conducted by third-party research firms, the discount card program’s success may be mixed.

Under the card program, Medicare beneficiaries will have access to over 70 national, regional and state discount cards that receive “endorsement” from Medicare but will be administered by private companies such as pharmacy benefit managers or pharmaceutical manufacturers. Card sponsors can charge an annual enrollment fee of as much as $30 and likely will offer savings on at least one medication in each of 209 classes of treatments commonly used by Medicare beneficiaries. Low-income beneficiaries not enrolled in Medicaid or private insurance can qualify for a $600 annual subsidy for their prescription drug costs and will not have to pay enrollment fees.

The Centers for Medicare and Medicaid Services (CMS) announced on Tuesday that almost three million beneficiaries are enrolled discount card program; 2.3 million of the enrollees, though, were automatically enrolled due to their participation in a Medicare managed care plan. Approximately 500,000 beneficiaries have signed up independently. Both statistics fall well short of the 7.3 million beneficiaries expected to enroll according to Bush Administration estimates. Although the Administration refused to reiterate its estimates, CMS Administrator Mark McClellan predicted this week that "hundreds of thousands" of new applications will be approved in the coming weeks.

A major report published on Thursday by the Kaiser Family Foundation described Medicare beneficiaries as "confused and generally negative" about the new Medicare prescription drug discount card program and, more important for the long term, the new Medicare drug benefit that will be available in 2006. The Kaiser report was based on 10 focus groups conducted in Pittsburgh; Kansas City, Kan.; and Washington, D.C., by pollsters from Democratic firm Peter D. Hart Research Associates and Republican firm Public Opinion Strategies.

The report examined Medicare beneficiaries’ attitudes toward the discount cards and the new prescription drug benefit. Seniors in the focus groups rated their feelings toward the new law at an average mean score of 31, on a scale ranging from one to 100, with one being the most negative and 100 the most positive. Even after receiving a description of the new programs and their implications, opinions improved slightly to an average of 36. The report also found that many seniors did not think that the discount cards nor the $600 annual subsidies were substantial enough. Further, many seniors said it was hard for them to choose one of the 70+ available cards. With regard to the drug benefit in 2006, Medicare beneficiaries were "not much more favorably inclined" with many expressing concern about the so-called "doughnut hole" in drug and about the penalty for beneficiaries who do not sign up for coverage when it is first offered to them.

Health Care News and Publications

Partial Birth Abortion Ban Reversed

On Tuesday, June 1, U.S. District Judge Phyllis Hamilton ruled that the hotly contested Partial Birth Abortion Ban Act was unconstitutional. Ruling in favor of Planned Parenthood Federation of America and City and County of San Francisco, Hamilton stated in her 117-page opinion that the ban was unconstitutional because the ban places undue burden on women seeking abortions. She characterized the language of the bill as “dangerously vague,” possibly encroaching other forms of abortion and that the bill neglects to include a required exception to protect a woman’s health.

The case closely follows on the heels of recent medical privacy cases in which PPSV’s own Jim Pyles has been participating. On Tuesday, June 1, Mr. Pyles participated in an expert panel discussing HIPAA and the recent abortion privacy cases. Information about the conference can be obtained at the American Bar Association’s website here.

PPSV’s Managing Partner to Lead Audio Conference on OIG Guidance on Discounts and Waivers

On Thursday, June 17, PPSV’s Managing Partner Robert Saner will be leading an audio conference entitled “OIG Guidance on Discounts and Waivers: The Effect on Group Practice,” for the Medical Group Management Association, along with MGMA’s Government Affairs Representative Jennifer Searfoss Miller.

The conference will focus on the government’s rule covering Medicare, Medicaid, and the children’s health insurance program, the application of OIG guidelines to common discount and waiver situations, and the necessary compliance program elements for group practices to implement discount and waiver policies.

The conference is scheduled for Thursday, June 17th from 2 p.m. EST until 3:30 p.m. EST. Registration for the conference closes Tuesday, June 15th. For more information on the audio conference or to register, please call 877-ASKMGMA (275-6462) or visit the MGMA website at www.mgma.com/education/calendar. The conference price is $179 for MGMA members, $189 for affiliates, and $239 for non-members. An audiocassette or CD along with the written materials package will be available for purchase after the conference.

Upcoming Events

Hearings


Tuesday, June 8, 2004

Committee on Finance
10:00AM
215 Dirksen Senate Office Building
Hearing - Medicare Drug Card: Delivering Savings for Participating Beneficiaries
Witnesses:
-Firman, James
Chair, Access to Benefits Coalition; President and CEO, National Council on the Aging
-Gross, Kris
Director, Iowa Senior Health Insurance Program
-Hayes, Robert
President and General Counsel -Medicare Rights Center
-McClellan, Mark
Administrator, Centers for Medicare and Medicaid Services
-Merritt, Mark
President, Pharmaceutical Care Management Association
-Snedden, Tom
Director, Pennsylvania's Pharmaceutical Assistance Contract for the Elderly

Thursday, June 10, 2004
Committee on Energy and Commerce--> Subcommittee on Oversight and Investigations
9:30AM
2322 Rayburn House Office Building
Hearing - A Review of Hospital Billing and Collection Practices

For More Information

For further information on any topics discussed or publications listed, or to get copies of anything mentioned in this alert, please call (202) 466-6550 and ask for the Legislative Practice Group.

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