Centers for Medicare/Medicaid Services (U.S.): CSC Helps Launch Medicare Part D by Sponsoring Discount Drug Cards

The Medicare Part D Prescription Drug Benefit Program was enacted in December 2003 as part the Medicare Modernization Act. The legislation mandated the creation of prescription drug plans for people with Medicare, along with the issuance of drug discount cards as an interim solution until the full Part D could take effect in 2006.
In April 2004, CSC was chosen as one of only 32 approved sponsors to support the Medicare Drug Discount Card program, which enabled Medicare beneficiaries to receive savings on prescription drug purchases and provided $600 in transitional assistance to lower income Medicare beneficiaries. In addition to supporting Medicare beneficiaries countrywide as an approved sponsor, CSC was endorsed by the Centers for Medicare and Medicaid Services (CMS) to serve two special groups. The company was one of only two Medicare sponsors to receive a special endorsement to offer a Discount Card to American Indians/Alaskan Natives, and one among three sponsors chosen to serve residents of long-term care facilities nationwide.

CSC: Diverse Skills for Every Element of the Program

A team of 60 CSCers in Maryland, New York and Ohio administered the complex elements of the program — from processing enrollments to working with more than 54,000 pharmacies nationwide; from answering phone calls to resolving grievances; and from financial management — including monitoring the utilization of low-income beneficiaries, collecting enrollment fees as necessary and making sure the pharmacy gets paid — to compliance and reporting, which involves following the guidelines of the Medicare Modernization Act, the Privacy Act and HIPAA.

Overarching the entire program was the client relationship, where CSC leveraged its close working relationship with CMS to facilitate effective communication and problem solving. In the words of Louis Hogan, CSC’s former director for pharmacy programs, "The depth and breadth of CSC’s portfolio of business with CMS has allowed us to develop solid working relationships with CMS staff. We understand the priorities of the agency, and the constraints CMS staff face every day."

Working with Community-Based Pharmacies

CSC had two primary partners. One was MemberHealth, Inc., a small and highly innovative pharmacy benefit manager based in Cleveland, OH. MemberHealth, which had been instrumental in introducing CSC to this exciting and growing opportunity, was responsible for all negotiations with pharmaceutical manufacturers and for establishing network agreements with the 54,000 pharmacies who accepted the CSC Drug Discount Cards.

CSC’s other major partner on the program was the National Community Pharmacy Association (NCPA), an association of 24,000 independent, community-based retail pharmacies. NCPA not only contributed its Community Care Rx brand to the program, but also helped promote enrollment and educate beneficiaries about how the program worked.

As part of the special endorsement CSC received to support Medicare beneficiaries living in long-term care facilities, the company also worked with a network of long-term care pharmacies. About 2,600 of such pharmacies endorsed CSC’s program, and the CSC team worked closely with them to ensure the best service to this special group of beneficiaries.

A Challenging Startup

Among the biggest challenges the CSC team faced was the startup time. CSC had to be ready to accept enrollments and start working with Medicare beneficiaries in May 2004, only five months after the Part D legislation was passed. Because it was a new program, the CSC team was implementing policy as it was being created, working with CMS to interpret policy details, answer questions from confused beneficiaries, and help pharmacists understand the program.

Education, Communication, Outreach
What has helped CSC succeed, in that initial phase as well as throughout the first year of the program, is a core CSC skill: communicating effectively with the diverse groups with whom we were partnering. “Our team has weekly mailings to the pharmacy community. We participate regularly in conferences and regional training sessions. We also work closely with consumer groups like the Access to Benefits Coalition, AARP, and others to reach out to our target audience,” explains Hogan. “Finally, CSC has a special outreach program for the American Indian/Alaskan Native population — a group we’re especially proud to serve.”

CSC’s team members have contributed their own specialized skills to strengthen the program. In addition to NCPA and MemberHealth, CSC works with the Senior Care Pharmacy Alliance to ensure that seniors residing in assisted living facilities receive cost-effective medication.

Racking Up Big Numbers
When the Drug Discount Card operations ended on May 16, 2006, according to the government’s schedule, CSC was one of the top three providers in the program. The results speak for themselves: :

• More than 450,000 enrollments processed
  
• More than 12 million claims processed
• Over 6 million prescriptions processed — an average of 30,000 per day
  
• An average of 2,000 calls answered every day from Medicare beneficiaries
• Savings realized by participating Medicare beneficiaries: $34 million (on the discount-only card) and $206 million (on the $600 credit received each year by low-income beneficiaries)

Success Turns the Tables
Perhaps the greatest proof of success came when Medicare Part D was fully implemented. On the heels of a strong track record with the drug card program, our partner MemberHealth won a contract from CMS to operate a Prescription Drug Plan under Medicare Part D. CSC helped out on the proposal and bid. On January 1, 2006, MemberHealth implemented its nationwide sponsorship of NCPA’s Community Care Rx Prescription Drug Plan.
CSC is now proud to serve as a subcontractor to MemberHealth providing a range of support including regulatory compliance, fraud detection, enrollment processing and call center services. Enrollments in the Community Care Rx program topped the million mark during our first six months of processing. Our call center handled approximately 1.5 million calls during its first six months.

As the Drug Discount Card program prepares to transition to the full Part D Prescription Drug Benefit Plan in 2006, CSC is confident that the experience the CSC team has gained will help the company perform equally well on the new program. As Hogan sums it up, “We hope to leverage the ‘trusted vendor’ environment as we work with CMS to implement the new Part D Medicare Drug Benefit program.”