CMS Rejects Waiver for Wisconsin’s Senior Drug Coverage Plan

The Centers for Medicare & Medicaid Services (CMS) rejected Wisconsin’s request to continue its prescription drug plan for seniors, which allowed the state to offer prescription drugs at lower prices through negotiations with drugmakers, Gov. Jim Doyle said.

The waiver allowing the plan, called SeniorCare, will expire June 30, CMS Acting Administrator Leslie Norwalk said. Wisconsin did not provide the CMS with required information proving the program was cost-neutral and saving taxpayers’ money, nor did it include information about the assets of program participants, she added.

At a recent Senate Special Committee on Aging hearing, Doyle said the expiration of SeniorCare would force seniors to pay higher prices under Medicare (DID, March 29). The state government is currently working to find ways to provide prescription drugs to seniors, but seniors will most likely have to switch to Medicare Part D plans, Doyle said.

The CMS would consider allowing a private, state-led program that supplements Medicare Part D, according to Norwalk. The state administration will consider that type of program, but it is also looking at other alternatives, Doyle responded.

Switching to a plan based on Medicare Part D will be more expensive for taxpayers and will raise the prices of drugs for seniors because Medicare does not negotiate prices with drugmakers, Doyle said. Discounts through negotiations save the SeniorCare program $62.2 million annually, according to the state government. SeniorCare will cost the state $57.6 million and the federal government $53.6 million this year.

Wisconsin is the only state with its own prescription drug program. Several other states have transferred from their own plans to Medicare Part D plans without major cost increases, despite the lack of price negotiation with companies, Norwalk said at the committee hearing. — Emily Ethridge