Medicare Issues Marketing Guidelines for
Prescription Drug Plans
Aug. 15, 2005 – With the advertising barrage just
beginning by the companies that will be selling Medicare approved
prescription drug plans to senior citizens for 2006, Medicare today
issued marketing guidelines for the companies and warnings for
consumers. People with Medicare can begin to enroll in the program on
November 15, while plans can begin to market their packages on October
1.
The guidelines will set standards that companies
must follow in marketing their plans to the nation’s elderly and
disabled.
What Consumers Should Know
To protect against fraud or unwanted
solicitations, consumers should be aware that:
• They should not give out personal information
(e.g., Social Security Numbers, bank account numbers, credit
card numbers, etc.) to plan marketing representatives, because
plans are not allowed to request such personal information in
their marketing activities.
• Plans cannot call outside of the calling hours
allowed by the federal government and states. Federal rules do
not allow telemarketers to call before 8 a.m. or after 9 p.m.
State rules may vary.
• To stop repeated and unwanted sales calls,
beneficiaries simply need to say “stop:” plans are required to
honor “do not call again” requests from beneficiaries. To
register for the federal “do not call” list to prevent all
unsolicited marketing calls, go to
www.donotcall.gov.
• Additional information about drug plan options from
an independent source, beneficiaries can go to
www.medicare.gov, call 1-800-MEDICARE, or seek help from the
local State Health Insurance Assistance Program or Area Agency
on Aging to get personalized information about which drug plan
may be best for them.
The new drug program – Medicare Part D – is not
mandatory. Beneficiaries who sign up for the drug coverage will pay
monthly premiums to the private companies provide the drug insurance.
The monthly premium is expected to be about $32.20, though can vary by
plan.
“The standards reflect proven methods plus ongoing
Medicare oversight to protect beneficiaries from unscrupulous or
overzealous sales tactics, while enabling them to get information they
can use to help make their decisions about this important new benefit,”
says a fact sheet issue by the Centers for Medicare and Medicaid
Services (CMS).
“The guidelines will govern the marketing
activities for stand-alone prescription drug plans (PDPs), Medicare
Advantage plans, and Medicare Advantage prescription drug plans,” says
CMS.
The marketing guidelines issued today they say
will:
•
Protect beneficiaries’ rights and privacy
•
Ensure that beneficiaries get accurate and consistent information about
their drug coverage options; and
•
Build on previous experience in the federal employees’ health program
and the Medicare Advantage program to help avoid unnecessary
administrative burdens for plans that consistently follow Medicare
guidelines.
These final guidelines reflect the input, feedback
and recommendations that consumer and industry groups provided on
earlier draft guidelines. The guidelines released today improve on the
draft guidelines in a few specific areas:
•
Combining the updated Medicare Advantage marketing guidelines with the
new guidelines for the Medicare prescription drug plans so that there is
a single reference document for plans that offer both.
•
Outlining the roles of independent agents and brokers;
•
Providing parameters where plans may “co-brand” with other
organizations;
•
Allowing plans that demonstrate consistent adherence to the guidelines
to “file and use” submitted materials, based on well-established
practices from the FEHBP program;
•
Requiring plans to follow the federal “do not call” requirements and all
other federal and state requirements for telemarketing, to protect
beneficiaries from unwanted or improper calls from plans; and
•
Providing details on what types of promotional activities plans may
employ.
These guidelines underscore the steps that CMS says
it will take to assure strong oversight of marketing activities,
including imposing sanctions where applicable.
Protecting beneficiaries’ rights and privacy
The marketing guidelines prohibit Medicare
Advantage plans, PDPs or their representatives from making door-to-door
sales calls or sending unsolicited e-mails. If plans use brokers or
independent agents, those individuals must adhere to state licensing
requirements. Plans that employ marketing representatives must ensure
that those representatives meet all state requirements, including state
licensure and certification or registration.
If plans and their representatives phone
beneficiaries to offer plan information, plans must comply with the
National Do-Not-Call Registry, honor “do not call again” requests, and
abide by federal and state calling hours and any other applicable
requirements.
CMS will investigate any complaints made by
beneficiaries and other organizations. CMS will implement a monitoring
system that will include beneficiary satisfaction surveys, a complaint
tracking system and periodic site visits. The agency will also work
closely with consumer protection groups and PDP organizations to educate
consumers about what should be in service contracts and what red flags
to look for. Beneficiaries who suspect a problem can contact CMS or
call 1-800-MEDICARE.
CMS will take appropriate action against plans
found to be non-compliant, committing fraud or otherwise violating state
or federal laws, which may include implementing corrective action plans,
imposing sanctions that may close the plan to new enrollees, imposing
civil monetary penalties or referring plans to the HHS Office of the
Inspector General or to other federal or state law enforcement agencies.
Promotions and Provider/Pharmacist Roles
Many people with Medicare rely on their
neighborhood pharmacists and other health care providers for information
about their prescription drugs and coverage. Physicians, pharmacists
and other health care professionals can provide objective information
regarding specific plans, covered benefits, cost sharing, drugs on
formularies and utilization management tools. Under the final
guidelines, these providers can make available plan marketing materials
and they can display posters or other materials announcing the
contractual relationship between the plan and provider. But providers
cannot steer beneficiaries to a plan to further their own financial
interests. Providers may, however, help a beneficiary choose the plan
that best meets their needs The guidance includes additional
information regarding “Cans” and “Cannots” for providers that have
contracted with PDPs.
CMS will provide information to various
organizations so that providers and pharmacists understand their role in
helping beneficiaries find a plan that best suits their needs.
“File and Use” Certification
The final guidelines use a “File and Use”
certification program that is modeled on a similar program used by the
Federal Employees Health Benefits Program (FEHBP). File and Use
certification allows plans to submit and certify that certain types of
materials meet CMS marketing guidelines. Medicare Advantage plans must
provide this information to CMS at least five days before they begin to
be used. Under the File and Use certification, plans may be able to use
CMS-provided “model language” for certain marketing materials, as long
as the model language is not modified. Activities such as advertising
are included under File and Use Certification and provide assurances to
beneficiaries that the information they receive is consistent across
plans.
File and Use Eligibility allows plans that follow
Medicare’s marketing guidelines to publish and distribute certain
materials without prior approval. To qualify for File and Use
Eligibility, plans have to meet a particular standard of performance and
a standard for certain types of materials continually.
CMS will monitor the use of these certifications
through retrospective sampling to ensure that plans are compliant with
the guidelines. CMS will also analyze feedback from the public and the
industry to ensure compliance.
Plans which are found to have compliance problems
in their materials can lose their File and Use Eligibility.
