WASHINGTON, Jan. 13 (UPI) -- Medicare will not reimburse states that paid for prescriptions because of glitches in the new federal drug benefit, Centers for Medicare and Medicaid Services Administrator Mark McClellan said Thursday.
Instead, they should seek reimbursement from insurance companies.
And frustrated seniors should place some of the blame for the rocky start of the Medicare Part D prescription-drug benefit on health plans as well, he added.
"Under this program, we do not have the authority to pay states directly," McClellan told United Press International in an interview taped for C-SPAN that airs this weekend.
"People are in Medicare drug plans, and it's the plans that are supposed to pay for people's prescriptions.
"What we're doing with states using their state systems is getting them in touch with the drug plans that are providing coverage so that the drug plans can reimburse them."
On Jan. 12, California, Illinois and Pennsylvania joined the nine other states that already passed emergency spending measures to ensure that seniors are able to fill their prescriptions as they transition to the Medicare Part D plan.
Seniors previously on Medicaid who have been automatically shifted to the Medicare plan have reported the most difficulty getting drugs at the low price they are entitled to under the plan.
The same day lawmakers in Nevada voted against a similar measure because the federal government has not committed to reimbursing states that pay for seniors' prescriptions when they are turned away or charged too high a price at pharmacies because of problems with their new Medicare drug coverage.
But states who work with Medicare before problems arise can avoid the need for reimbursement altogether, McClellan said, adding that only a minority of states have had widespread problems.
"People are getting their medications, states are working with us to get them into these programs, and that's the best way to make this transition," he said.
McClellan also placed some of the blame for problems at pharmacies with prescription-plan providers.
Long waits for seniors at pharmacies and other customer-service lapses are largely due to the low customer service capacity of providers and not Medicare itself, he said.
"Some of the plans have had a very high level of calls relative to what they've been able to staff to provide customer service. We have gone back to those plans and are working with them to get them to increase their level of customer support more quickly," he said.
The 1-800-MEDICARE hotline sponsored by the agency itself is fully staffed and most calls are answered in less than 15 minutes, and Medicare is also watching companies to ensure that they don't pare down their lists of covered medications or fail to provide a minimum standard of service, he said.
If they do, they could face financial penalties or have their contracts cancelled, McClellan added.
Data on the relative performance of the companies will also be made public, so that the market can reward companies that meet customers' needs.
"The plans that are going to do well are the ones who provide good customer service," he said.
