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On a recent November day, Tim Tucker and his brother, both pharmacists in Huntingdon, Tenn., sat down with more than a dozen customers individually at their family-owned pharmacy to help them wade through the increasingly complex morass that is Medicare Part D, the federal government’s optional drug plan for Medicare enrollees. This time of year, the duo spends more time counseling than they do filling prescriptions as their customers try to decide by the end of the year whether the plan in which they’re enrolled is best for them, or whether they should switch to another one.

“At its inception, Medicare Part D’s authors and promoters envisioned the plan would be easily understood, and patients could decide which plan was best for them. In Tennessee, we’ve had between 40 and 50 plans the first two years and for year three, which is getting ready to start, we have even more plans than we’ve had the first two years. I know for my population in Tennessee, it’s extremely difficult for my patients to understand the different plans, the complexity of the plans,” said Tucker, who sees the issue from another perspective as well. The Tennessee native is a past president of the Tennessee Pharmacists Association and is the president-elect of the American Pharmacists Association (APhA), which championed Part D.

“In the general sense, we have absolutely accomplished part of the goals of the program. Are we where we need to be? No,” Tucker said. “I think the next step legislatively has got to be to make it a more simplified plan for the Medicare population to understand.”

Tucker said that “with a lot of pressure from outside sources,” the Centers for Medicare and Medicaid Services decided to privatize Part D. Thus, a dizzying array of choices entered the market, and those choices shift annually as plans come, go and change. “That makes it so very, very confusing. It’s confusing to me as a healthcare practitioner,” he said.

According to research funded by the Kaiser Family Foundation, 1,824 stand-alone Part D plans will be offered in markets across the country in 2008, with premiums ranging from $9.80 a month to $107.50 a month. If an enrollee stays with the same plan from 2007 to 2008, the average monthly premium will rise from $27.39 in 2007 to $31.99 in 2008. That’s a 17 percent increase. Nearly one in five of this year’s enrollees will experience an annual increase of at least $120 if they stay with the same plan next year.

For the sake of their patients and their patients’ pocketbooks, physicians and other healthcare providers need to stay abreast of this issue, Tucker added, and encourage their older patients to annually review their Part D coverage. Physicians may also be able to help their patients by, whenever possible, prescribing drugs covered by the patient’s plan. Tucker said he doesn’t hesitate to call a physician and suggest an alternate drug if it would save his customers money.

“Whether enrollees want to change their plan or not, it behooves them to sit down and look at the options. Every plan has changed this year for next year on coverage parameters. Even if a patient has a plan that they think is the most wonderful plan in the world, it will be very important for them to reevaluate, just to make sure that’s still the right plan for them.”

Plans differ in the medications that are covered, the premiums and, depending on those and other factors, the coverage gap. Enrollees reach that gap after they incur $2,510 in total drug costs in 2008. At that point, they have to pick up 100 percent of their drug costs until they qualify for “catastrophic coverage.”

“That big bear called the coverage gap is something else that the legislature has to address. Financially, that’s a huge issue,” Tucker said. Some patients may hit the gap as early March, and face thousands of dollars in out-of-pocket drug expenses. “They can’t afford to do that, so we’ve really got to look hard at that,” he said.

Tucker explained that “dual-eligible patients, which means in our state they have TennCare and Medicare, will never have a coverage gap. But for your average senior patients who are retired, they hit a coverage gap. They get to a magic number and that number floats.”

Pharmacists themselves also have issues with Part D, and that problem is payment. “There’s a real lag time right now with some of the plans getting payment to providers. With the providers having more and more Medicare Part D patients, we’ve got to make sure that our providers are made whole so that they can continue to take care of patients,” he said.

Tucker said the APhA will be working to push Part D improvements through the system during 2008, while their members continue to help patients understand the issues. “I don’t want anybody to think that there’s not somebody who can help them,” he said. “Some folks in larger cities may not have a Tim Tucker, but I would hope every pharmacist would take the time to help their patients.”

He suggested enrollees call 1-800-MEDICARE or, if they have Internet access, visit www.medicare.gov or www.managepartd.com.




December 2007

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