The Associated Press

Mon, Jul 28, 2008 (3:21 p.m.)

Complaints about the Medicare drug benefit have dropped considerably since the summer of 2006, but ongoing challenges still pose problems for participants, particularly in getting complaints addressed promptly.

Investigators tracked nearly 630,000 complaints filed with the federal government during an 18-month period ending Oct. 31. More than 25 million people are enrolled in Medicare drug plans or in drug plans that offer comprehensive Medicare benefits.

By the end of the review period, the monthly complaint rate had dropped about 74 percent from peak levels _ to 1.5 complaints per 1,000 Medicare beneficiaries. Also, the time needed to resolve the complaints dropped from 33 days to nine days.

Still, auditors had concerns that many of the most critical complaints _ those filed when beneficiaries were at risk of exhausting their medications _ were not resolved promptly. The most severe complaints, involving patients with less than two days' worth of medication, are supposed to be resolved within two calendar days. However, auditors found it took the Centers for Medicare and Medicaid Services 12 days on average to resolve those complaints. More than half of such complaints were not resolved within the agency's time standards.

"Further, progress in meeting the time frames, particularly for immediate need cases, largely stagnated from March 2007 to October 2007," said auditors with the Government Accountability Office.

Democratic lawmakers who requested the GAO report were critical of Medicare officials' work in resolving complaints.

"CMS needs to do a better job of protecting beneficiaries," said Rep. Henry Waxman, D-Calif. "The complaint resolution process is taking so long that seniors could run out of essential medicines."

Kerry Weems, acting administrator at the agency overseeing the drug benefit, said he agreed with the GAO's findings for the period reviewed. However, he noted that the agency did better in subsequent months in meetings its standard for resolving complaints. In the six months ending in April, Weems said the most urgent cases were resolved within three days on average.

GAO also analyzed grievances filed directly with the drug plans. Auditors reported that CMS encourages enrollees to file grievances directly with plans when they have problems, but the agency is conducting little oversight of this process. Auditors said, "There is little assurance that beneficiaries' grievances are resolved," or that they are "resolved in a timely manner."