Medicare Officials Revise Drug Plan Amid Criticism

People enrolled in the Medicare drug plan will still get coverage for the pills they’re taking even if insurance providers change their lists of preferred treatments, according to revised guidelines disclosed Thursday.

Insurers offering the plans can make customers switch to another drug only when a cheaper generic version is available or safety concerns arise, according to the Centers for Medicare and Medicaid Services, which oversees the program. Safety issues may include questions resulting from research or warnings from the Food and Drug Administration.

“No beneficiaries will be subject to a discontinuation or reduction in coverage of the drugs they are currently using, except for clear scientific and cost reasons including the availability of a new generic version of the drug,” Abby L. Block, director of the Center for Beneficiary Choices, said in a letter to insurers.

The notice responds to concerns from members of Congress such as Sen. Susan Collins (R-Maine) that drug providers will switch consumers to different pills based on drug makers’ discounts. The Medicare drug benefit started Jan. 1 and has drawn millions of elderly and disabled people who chose plans based in part on which drugs were included.

“The previous policy subjected seniors and disabled individuals to a potential ‘bait and switch’ situation where they would choose a plan because it covered the drugs they were taking, only to have the formulary changed after they enrolled,” Collins said Thursday.

Rep. Pete Stark (D-Fremont) described the change as “better late than never.”

“I hope this is the first of many actions to fix the myriad of problems with the confusing Republican drug program,” he said.

The trade association representing the insurance industry, America’s Health Insurance Plans, also endorsed the proposal. Plan sponsors may need to make formulary changes during the year to provide Medicare beneficiaries with a drug benefit that reflects the latest in scientific evidence, the board members said in a statement.

“At the same time, AHIP members strongly support maintaining continuity of care if a formulary change is made,” they said.