Medicare Part D lawsuit against Leavitt settled

SAN FRANCISCO The case of Situ v. Leavitt, which involved low-income dual eligible Medicare beneficiaries suing Health and Human Services Secretary Michael Leavitt regarding poor management of the Medicare Part D prescription program, has been settled.

The plaintiffs had argued that the poor management of the program created ongoing barriers for themselves, by causing delays when the patients signed up for drug plans or when they were forced to switch plans every year due to plans going out of business and new plans starting in their place.

As part of the agreement, the Bush administration will change how HHS and the Centers for Medicaid and Medicare Services will be operated for dual eligible Medicare beneficiaries. Some of these changes for CMS include:

• Speed up the enrollment process for new dual eligibles. Instead of waiting several weeks to process files received from states identifying new dual eligibles, CMS will process these files within one business day of receipt. CMS will also allow states to submit these files more frequently.
• Require plans and CMS Regional Offices to provide additional assistance to beneficiaries whose names are inadvertently missing from pharmacy or plan computer systems. New protocols will shift the burden of proof away from beneficiaries and to providers when eligibility is in question.
• Educate pharmacy organizations about new policies intended to increase protections for dual eligibles who are not automatically enrolled in a plan and, therefore, are unable to obtain medications.

“This settlement agreement is a victory for many of our nation’s most vulnerable citizens,” said National Senior Citizens Law Center Staff Attorney Kevin Prindiville, which was serving as counsel for the plaintiffs. “These individuals have faced life-threatening delays in receiving vital medication. They do not have the means to front the costs of their prescription drugs while Medicare and the plans sort out paperwork. We view the administration’s agreement to this settlement as a sign that it is now committed to providing adequate protections for these beneficiaries.”