September 3, 2020
VIA ELECTRONIC SUBMISSION
The Honorable Robert P. Casey, Jr.
United States Senate
393 Russell Senate Office Building
Washington, D.C. 20510
The Honorable Elizabeth Warren
United States Senate
309 Hart Senate Office Building
Washington, DC 20510
Re: Potential Impact on Medicare Beneficiaries Due to Recent Changes at the United States Postal Service (USPS) Causing Delays in Delivery
Dear Senators Casey and Warren:
The Center for Medicare Advocacy (the Center) is writing out of concern that recent changes to United States Postal Service (USPS) operations are detrimental to Medicare beneficiaries who rely on the mail to receive prescription drugs and Medicare-covered items and supplies.
The Center, founded in 1986, is a national, non-partisan law organization that works to ensure fair access to Medicare and quality health care. We provide education, advocacy, and legal assistance to ensure people receive the Medicare coverage to which they are legally entitled and the quality health care they need. Additionally, we draw upon our direct experience with thousands of individuals to educate policy makers about how their decisions affect the lives of real people.
Timely access to prescription drugs and medically necessary items and supplies is critical to the well-being and continuity of care of Medicare beneficiaries. The current COVID-19 public health emergency has had a disproportionately harmful impact on older adults, and necessitates minimizing contact with other people. As more people avoid picking up their drugs and supplies at pharmacies and other places of business, older adults and individuals with disabilities are even more dependent upon the postal service to provide a bridge to the outside world.
It has come to our attention that, due to recent USPS changes, some suppliers of Part B covered diabetic testing supplies have switched from using USPS to other delivery services, such as FedEx and UPS, in order to ensure consistent and timely delivery. We can only assume that Part D plan sponsors have been forced to contemplate doing the same. We note that Medicare Advantage enrollees, who often rely on limited options of contracted suppliers for Part B durable medical equipment, might be particularly susceptible to delivery options chosen by a given supplier.
It is quite possible that the full impact of USPS delays have not yet been felt by Medicare beneficiaries who rely upon the mail for delivery of needed prescriptions. Since Part D plans allow for 90-day supplies of mail order drugs to be provided to their enrollees, individuals who are part way through their supply have not had to rely on the mail since recent actions that have led to delayed delivery. For example, for those who began the calendar year with a 90-day supply of drugs – one supply each quarter – their next supply isn’t scheduled to start until the last quarter of year, starting in October.
In order to mitigate the harm caused by delays in deliveries by USPS, it our hope that Part D plan sponsors are using all available options to assist their enrollees. For example, the Medicare Prescription Drug Manual, Ch. 5, §50.12 outlines pharmacy access requirements during disasters or other public health emergencies, and states that if “the underlying circumstances are reasonably expected to result in a disruption in access to covered Part D drugs, CMS expects sponsors to lift their ‘refill-too-soon’ edits” when drugs are provided at the point-of-sale. Given USPS delays, on top of a pandemic, our hope is that this provision is enforced concerning mail-order drugs, and that plans work to ensure that their enrollees are able to obtain such drugs in a timely manner.
Further, while CMS has instructed contractors, plans, etc. to employ maximum flexibilities concerning processing appeals during the public health emergency, including finding good cause for delayed filings, based on our long experience with the Medicare program, we fear that not all entities will comply. While many aspects of appeals are handled via telephone or electronically, the mail is still relied upon for transporting official written notices, and necessary documents such as letters, medical records, etc. It is likely that requests for appeals and other relevant documents that are received after applicable deadlines will be treated as untimely by some actors and will prevent some beneficiaries from accessing the appeals process.
We urge Congress to address these and other impacts on Medicare beneficiaries due to recent actions at USPS leading to delays in deliveries. For additional information, please contact David Lipschutz, Senior Policy Attorney, dlipschutz@MedicareAdvocacy.org at 202-293-5760.
Associate Director/Senior Policy Attorney
Licensed in CA and CT