GOVERNOR'S DECISION TO END MEDICARE PART D "WRAP AROUND" BLOCKS ACCESS TO MEDICATIONS FOR THOUSANDS ON MEDICARE AND MEDICAID
Low-income elderly and disabled individuals across the state may soon walk out of the pharmacy with unfilled prescriptions. Authorization for state payment for drugs prescribed after June 1 for people on Medicare and Medicaid will no longer be available because of a unilateral decision by Governor Rell.
Getting medication will now require diligent follow-up by already confused patients, their busy prescribers, and pharmacists, for the drugs to be dispensed. In the meantime, there will be no help paying for these medications.
Prior to June 1, people on both Medicare and Medicaid sometimes had problems with their Part D drug plans and the restrictive "formularies," (lists of covered drugs). However, they were still able to obtain their drugs because of state payments, which acted as a safety net. Now Governor Rell is restricting payments for newly prescribed drugs and would like to entirely eliminate that safety net (called the "Wrap Around"). That would mean there would be no more state payments for drugs not covered through Medicare Part D, regardless of when the prescription was written, leaving tens of thousands of people without access to necessary medications.
Although this proposal was rejected by the state legislature, the Governor moved forward with it, effective June 1st.
The Center for Medicare Advocacy calls upon the state to continue to fund the Part D Wrap Around, says Judith Stein, Executive Director. "As the Governor and a unanimous legislature determined in 2005," continues Ms. Stein, "without the Wrap Around the health of tens of thousands of Connecticut’s most vulnerable older and disabled people will be in jeopardy. The end of the Wrap Around means that people with both Medicare and Medicaid – those who are poor and old or disabled – will get less help than younger people who just have Medicaid. This makes no sense."
The original Wrap Around legislation requires the Department of Social Services to follow up with private Medicare plans, and to appeal when necessary to get coverage. "The Center for Medicare Advocacy does these appeals efficiently," says Kate McEvoy, Assistant Director of the Agency on Aging of South Central Connecticut, "but the state has not implemented this process. Appeals should be pursued so that we can continue to help people get the medications they need and help the state pay for them."