The Biden administration announced Thursday that, starting in early spring, the 64 million people on Medicare will be able to get free coronavirus rapid tests from certain pharmacies.

The initiative responds to weeks of criticism from members of Congress and advocacy groups that Medicare, the vast federal insurance system for older and disabled Americans, was left out of an order issued by President Biden last month requiring private insurers to pay for at-home tests, which have become a critical tool in managing the pandemic.

As a result, people with the traditional form of Medicare have been able to get free tests only with a prescription from a doctor or other health-care practitioner, or from one of 20,000 testing sites nationwide — options that critics have decried as inadequate. About 4 in 10 Medicare beneficiaries have chosen a newer version of the program, known as Medicare Advantage, that relies on managed care plans. In that version, some insurance companies cover the tests, while others do not.

 

Administration officials said the main obstacle has been that the law and regulations for the traditional version of Medicare do not allow for coverage of over-the-counter medical products, such as the coronavirus tests people use at home.

In a “news alert” issued Thursday by the Centers for Medicare and Medicaid Services (CMS), officials said a new initiative will enable people on Medicare to get up to eight tests a month through “eligible pharmacies and other participating entities” starting in early spring. The announcement noted that this is the first time the insurance program has covered an over-the-counter test at no cost to consumers.

The announcement did not say how many pharmacies or other retailers will participate, where they will be located or on what date this will begin. Health officials said CMS, the agency within the Department of Health and Human Services that oversees Medicare, will directly pay the pharmacies and other places selling test kits, allowing people with Medicare to get tests without having to pay.

“We wanted to be able to put out an announcement, ‘Look, help is on the way,’” said Meena Seshamani, director of CMS’s Center for Medicare. She said in an interview that the agency figured out it could devise a method to pay pharmacies and other places for the tests. To do so, it is relying on permission Congress has long given the Medicare program to experiment with payment and benefits rules if an innovation seems likely to improve access to care or lower costs.

Seshamani said this initiative will include pharmacies that already participate in Medicare, plus additional stores that are willing to take part. Federal health officials conducted the first large planning call on Thursday with pharmacies and other potential participants. It was not yet clear what other type of retailers will take part.

The agency did not immediately have figures available for how many pharmacies already are set up to be paid by Medicare for other purposes. Asked how CMS will make free tests available in communities with limited health-care services or in rural areas, Seshamani said, “As we are working through getting this up and running, we will be thinking about equity.”

She said it remains unclear whether providing free coronavirus tests could increase expenses in the portion of Medicare that pays for care outside hospitals — and whether that could, in turn, lead to higher monthly premiums for people with Medicare. CMS will be “working through and thinking through” those issues, she said.

Pointing out that this will be the first time since Medicare’s creation in 1965 that it will cover an over-the-counter product, Seshamani said, “This is unprecedented, putting something in place and dealing with those complexities.”

The administration’s announcement was immediately welcomed by some lawmakers on Capitol Hill who had written to Biden or HHS Secretary Xavier Becerra, urging them to provide Medicare recipients with coronavirus at-home tests free of charge. Calling the CMS announcement “a common-sense decision,” Rep. Bill Pascrell Jr. (D-N.J.), who had written to the president, said in a statement, “Giving our seniors this peace of mind will increase testing, decrease infection rates, and ultimately save lives.”

The health insurance industry, which includes Medicare Advantage plans, praised CMS’s move. Matt Eyles, president of AHIP, the industry’s main trade group, said in a statement: “This is a commendable model and the right path … to ensure equitable access, swift treatment and an effective response to the virus.”

AARP, the large advocacy group for Americans 50 and older, also praised the announcement.

“Every American should have an easy way to get at-home covid tests,” Nancy LeaMond, AARP’s executive vice president, said in a statement. “We know that people 65 and older are at much greater risk of serous illness and death from this disease — they need equal access to tools that can help keep them safe.”

LeaMond alluded to the fact that much of the initiative remains to be developed, saying AARP will watch for details to materialize.

Tricia Neuman, who directs the program on Medicare policy at the Kaiser Family Foundation, a health policy organization, was more explicit about the ambiguities surrounding how the initiative will play out.

“This is a step forward, but it’s too soon to say how easy it will be for people with Medicare to get free tests,” Neuman said. “That will depend on how many pharmacies become eligible to participate, whether these pharmacies and providers serve all communities, and how quickly this all happens.”

Fuente: Washington Post
Fecha: 02/03/22