[Congressional Record Volume 152, Number 14 (Wednesday, February 8, 2006)]
[Senate]
[Pages S865-S866]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN (for herself, Ms. Collins, Mr. Dorgan, Ms. 
        Snowe, Mr. Bingaman, Mr. Chafee, Mrs. Clinton, Mr. Schumer, 
        Mrs. Murray, and Mrs. Boxer):
  S. 2255. A bill to amend title XVII of the Social Security Act to 
prohibit removal of covered part D drugs from a prescription drug plan 
formulary during the plan once an individual has enrolled in the plan; 
to the Committee on Finance.
  Mrs. FEINSTEIN. Mr. President, today I am introducing legislation 
along with Senators Collins, Dorgan, Snowe, Bingaman, Chafee, Clinton, 
Schumer, Murray and Boxer to ensure that when a senior signs up for a 
Medicare prescription drug plan, the drugs covered by their plan cannot 
be removed or changed throughout that year.
  Under the legislation, if you sign up for a plan in January, the 
drugs covered by your plan will continue to be covered the rest of that 
year.
  If you become eligible for Medicare during the year, for instance you 
turn 65 in May, and you sign up for a plan, the drugs covered by your 
plan when you enroll in it will continue to be covered the rest of that 
year.
  At the end of the year, if a plan wants to change its coverage, it 
can do that. The bill does nothing to prevent plans from changing their 
drug coverage for the coming year. However, that can only happen at the 
end of the year, at the time all Medicare beneficiaries have the option 
to switch plans.
  Seniors deserve the peace of mind to know that the drug plan they 
enroll in will cover the drugs it says it will all year.
  Under current law, a prescription drug plan can change its formulary 
as many times as it wants throughout the year so long as it gives 
notice to its enrollees.
  However, seniors have no recourse other than going through a lengthy 
appeals process if their drug plan suddenly drops their medicines. At 
the end of that appeals process, there is still no guarantee that 
seniors will get their drugs.

[[Page S866]]

  Under current law, they have to wait until the next open enrollment 
period which may be as much as nine months away. That is unacceptable.
  Seniors can't and shouldn't have to wait all year to obtain 
lifesaving and life sustaining drugs they thought would be covered by 
their drug plan.
  The bill allows a prescription drug plan to add drugs to its 
formulary--for instance in cases where a new drug is approved by the 
FDA or a generic alternative to a brand name drug becomes available.
  The bill also allows a prescription drug plan to remove a drug from 
its formulary if the FDA issues a clinical warning about the drug, if 
the FDA pulls a drug from the market like in the case of Vioxx, or if 
the drug has been determined to be ineffective.
  But, in those instances, the prescription drug plan must notify the 
HHS Secretary, affected enrollees, physicians, and pharmacies of the 
change.
  Seniors in California have an overwhelming array of prescription drug 
plan options. There are at least 110 drug plan options for 
Californians.
  It can take days, if not weeks to determine which plan is best based 
on your drug needs and health status.
  Unless this bill is approved, seniors have no guarantee that their 
drugs will be covered throughout the year.
  I think that is wrong. This legislation will change that.
  Some might argue why this bill is necessary now. We are one month 
into the new Medicare drug benefit and what we have witnessed 
throughout the Nation is widespread confusion. Seniors are being turned 
away at the pharmacy counters and they are being incorrectly asked to 
pay hundreds of dollars for their drugs.
  States are absorbing the costs to provide drugs for a Federal 
program. So far, California has spent more than $18 million of its own 
money. I support efforts to reimburse States fully for the drug costs 
they've absorbed as a result of implementation errors by this 
Administration and I support transitional relief for the so-called 
``dual eligible'' Medicare beneficiaries whose transition from Medicaid 
to Medicare has been disastrous.
  The Administration contends that this legislation isn't necessary 
because plans can't change their formularies without notifying the 
Centers for Medicare and Medicaid Services (CMS) and enrollees first 
and that CMS won't allow plans to make changes to their formularies 
that hurt seniors.
  This ``just trust us'' argument being used by the Administration is 
anything but reassuring, especially given all the major program 
implementation problems it has caused due to poor planning and 
inadequate foresight.
  I believe seniors deserve more and they deserve the protections 
guaranteed under this legislation.
  We must act now to protect all Medicare beneficiaries from the type 
of ``bait and switch'' tactics like signing up for a plan thinking you 
were getting certain drugs only to find out down the road that those 
drugs were no longer covered.
  The bill is about parity for seniors. If seniors are prohibited from 
changing drug plans except during the annual open enrollment period, 
then they deserve to know that the plan they are locked in to is also 
locked in to covering the drugs it said it would.
  I urge my colleagues to support this legislation.
  Mr. DORGAN. Mr. President, I am pleased to join Senators Feinstein, 
Collins and a number of my other colleagues to introduce the Medicare 
Drug Formulary Protection Act of 2006. This legislation will improve 
the new Medicare prescription drug benefit by preventing prescription 
drug plans from unexpectedly dropping coverage of prescription drugs 
that were covered when seniors enrolled in the plan.
  Although seniors enrolled in the new Medicare drug program are only 
able to change their health plans once a year, nothing prevents 
insurers from dropping drugs from their plans on a whim. Under current 
law, prescription drug plans can change which drugs they cover as long 
as they provide 60 days notice to their enrollees.
  It is difficult enough for seniors to navigate the confusion and 
complexity the Administration has built into the Medicare prescription 
drug benefit. They ought to be able to do so secure in the knowledge 
that once they have picked a plan, the plan will not change on them 
midstream. Seniors need the protection and certainty this legislation 
extends to them.
  I had some hopes for this new Medicare plan, but it has become a 
complete and utter mess. In North Dakota, we have 41 different plans 
being offered by 17 different companies, and we have the highest 
percentage of senior citizens in the nation with no prescription drug 
coverage.
  In North Dakota, 68 percent of seniors still do not have prescription 
drug coverage. With the sign-up period nearly one-third over, only 
9,000 seniors in North Dakota have voluntarily signed up for the 
program. More than 70,000 seniors still lack coverage.
  Other States in the northern Great Plains region are not far behind. 
Fully 67 percent of South Dakota seniors have no prescription drug 
coverage and in Montana 65 percent lack coverage. Wyoming also ranks 
high, with 61 percent of its seniors without prescription drug 
coverage.
  I have asked Secretary Leavitt to dispatch a survey team to North 
Dakota and neighboring States to determine why enrollment rates in the 
new Medicare prescription drug program are among the lowest in the 
nation in our region of the country.
  In the meantime, we need to enact the Medicare Drug Formulary 
Protection Act and other commonsense reforms like the Medicare Informed 
Choice Act and the Medicare State Recovery Act.
  The Medicare Informed Choice Act would extend the enrollment deadline 
until December 31, 2006. We need to enact this legislation right away. 
Seniors need more time to evaluate their options. Extending the 
enrollment deadline will also give Congress time to address some of the 
problems that have kept more seniors from enrolling in the benefit.
  The Medicare State Recovery Act will ensure States are reimbursed for 
the cost of prescriptions for low-income seniors and people with 
disabilities who were improperly denied coverage under Medicare.
  I want this new benefit to work. That is why I urge my colleagues to 
support these efforts to improve the benefit and make it less confusing 
for seniors.
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