Press Releases

MEDICARE ISSUES INFORMATION ON COMPLAINTS ABOUT PRESCRIPTION DRUG PLANS

The Centers for Medicare & Medicaid Services (CMS) today posted sponsor-level data about complaints it has received about the services provided by the Medicare prescription drug plans in June.  Nationally, during the month of June, 2006, CMS received approximately 2.3 complaints per 1,000 Medicare beneficiaries enrolled in prescription drug plans.   Complaint rates averaged about 2.6 per 1,000 beneficiaries for stand-alone prescription drug plans (PDPs) and about 1.4 per 1,000 beneficiaries for Medicare Advantage drug plans.

“The relatively low number of complaints that we are receiving from beneficiaries is another indication that the vast majority of beneficiaries are getting a high level of service,” HHS Secretary Mike Leavitt said.  “While this is an important result, we are making sure that complaints and any underlying problems are being addressed and resolved as quickly as possible.”

   “Almost all of our beneficiaries are in plans with complaint rates substantially less than one percent,” said CMS Administrator Mark B. McClellan, M.D., Ph.D.  “To assure very low complaint rates, we are using these data to address plans’ weaknesses, to continue to find and fix problems and drive for excellence in the service they are providing to their enrollees.  We are particularly concentrating on the plans with relatively high rates.” 

Most complaints are about enrollment or disenrollment in a plan, when beneficiaries start or stop using coverage, reflecting one-time issues in “getting connected” to a plan.  A smaller share of complaints concern difficulties that beneficiaries have in getting needed drugs or plan customer service.  On average these rates are below one per 1,000 beneficiaries.   Very few beneficiary complaints involve other issues like problems with the exceptions or appeals process.  

CMS is using these data as the baseline to identify patterns of complaints and complaints that cannot be promptly resolved. Where plans’ rates are high and improvement is not seen in the subsequent month, CMS may closely monitor the plan to determine whether enforcement actions, such as restricting the plan’s ability to enroll beneficiaries or imposing fines, are warranted. Beneficiaries and their advisers can also use this information to help identify plans with excellence in beneficiary service.

These data come from a complaint tracking process that CMS has implemented to receive and resolve individual complaints about plan service. As part of this process, CMS monitors the number and type of complaints from calls to 1-800-MEDICARE, those referred through CMS’ regional offices and the Medicare Integrity Contractors. These complaints may come from beneficiaries, family members, pharmacists, and others who assist seniors and people with a disability. 

“It’s important for beneficiaries who have problems to begin by contacting their plan, because this usually leads to resolution of the problem,” said Dr. McClellan.   “But if the problem is not being resolved in a timely manner, we want to hear about it so that we can take any necessary actions to resolve the issue.  Beneficiaries can call us at 1-800-MEDICARE or 1-877-7SAFERX or work with our regional offices or many partners around the country to get the assistance they need. ” 

These data are part of CMS’ efforts to report on plan performance to help Medicare beneficiaries with decisions about their prescription drug plans.  CMS has also provided information on plan call center performance for assisting beneficiaries and pharmacists, and expects to update this information as well as to provide further information on exceptions and appeals and other aspects of plan performance as the data become available.

Complaint Rates for Medicare Advantage Prescription Drug Plans (06/01-06/30) [PDF, 879KB]

Complaint Rates for Medicare Stand-Alone Prescription Drug Plans (06/01-06/30) [PDF, 273KB]