Medicare Plan D problems persist

Since the new Medicare prescription drug plan went into effect Jan.1, doctors and pharmacists have struggled to sort through reams of dizzying formularies, figure out co-pays and sift through insurance plans. More than a month later problems of the initial implementation still exist.

"I don't think anything has gotten better or worse," says Robert L. Hogue, M.D., past president of TAFP. "Patients are still confused which plan to choose and I don't have the resources to help them."

An even larger concern is dealing with the restrictions in treatment once a patient has chosen a plan. Each of the 20 plans in Texas has a different formulary, which, according to Hogue, often means adjusting his patients' medical treatment based on the medications their plans cover.

"Patients finally find a treatment that works for them, then they choose a plan that doesn't provide any of their medications," Hogue says. "Whatever plan they choose, I have to deal with."

But even if a patient finds treatment that matches their drug plan, it's not always as simple as walking into a pharmacy and getting their prescription filled, says Jeff Carson, chief of staff at Oakdell Pharmacies in San Antonio.

"Things aren't as bad as they were at the beginning of the year, but it's still not pretty, and there's still a lot of confusion," Carson says.

Many problems occur with dual eligible patients. Either they have yet to show up on computerized rolls, or the computer shows a co-pay that doesn't coincide with their insurance plan's co-pay.

"I have a moral obligation to my customers [with serious illness], so I give them their medications even if they can't afford to pay," Carson says. "I just have to hope I will be reimbursed later on."

But independent pharmacies pay more for prescription drugs than bigger companies with greater buying power, according to Carson. This means reimbursements won't cover the cost for smaller pharmacies, forcing them to either go out of business or deny dual-eligible Medicare patients.

"Forty-four percent of all pharmacies in America are independent," Carson says, "if they can't afford to serve Medicare patients, it will have a huge impact on not only the patients but the health care system in general."

If Medicare Part D still seems like a Gordian knot, peruse our resources in the Practice Resources section of www.tafp.org. The newest tools include a pharmacist-to-physician fax form, formulary finder and a friends and family first toolkit. Resources are updated frequently, so visit often.