The Transition of Dual Eligibles to Medicare Part D Prescription Drug Coverage: State Actions During Implementation

This 50-state survey of Medicaid officials assesses states’ early experience relating to the transition of low-income seniors and people with disabilities enrolled in both Medicaid and Medicare (dual eligibles) to the Medicare Part D drug benefit. Conducted by Health Management Associates, the survey covers the types of problems observed by states during the transition of dual eligibles to the Medicare drug benefit, state actions to correct problems and ensure temporary coverage, and specific data on costs incurred by states from these temporary programs.

On January 1, 2006, the prescription drug coverage for over 6 million dual eligibles was transitioned from Medicaid into the new Medicare prescription drug benefit. Almost immediately, federal, state and local officials noticed problems that made it more difficult for some dual eligibles to obtain needed prescriptions. Because dual eligibles typically have more extensive health and prescription drug needs than other beneficiaries, many states had been preparing for problems and moved forward with temporary programs to ensure that these beneficiaries obtained needed medications during the transition to the Medicare drug benefit. The federal government has since committed to reimbursing the states for the costs associated with the temporary coverage programs.

Medicaid officials from all 50 states and the District of Columbia responded to the survey. It provides a state-by-state breakdown of temporary coverage programs, including the number of duals receiving prescriptions, total prescriptions, and the cost of coverage. The survey also finds that in the first month of implementation:

• Over 60 percent of states reported problems that affected a significant number of dual eligibles,
• 37 states implemented temporary coverage programs for dual eligibles, and
• The most common problems included incorrect cost-sharing charged to beneficiaries (49 states), pharmacies could not bill plans (44 states), and beneficiaries were unable to obtain non-formulary drug (43 states).

Report (.pdf)