Medicare Plan D problems persist

TAFP offers online resources

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.

TAFP's C. Frank Webber Lectureship and Interim Session begins next week

Less than two weeks remain until the 2006 C. Frank Webber Lectureship, and we want to see you there. Join your fellow family physicians on Friday, March 3 at the Hilton Austin Airport in Austin, Texas, for your chance to earn up to 11.5 credits of CME. Breakfast, lunch and dinner are included in your registration fee. To register, go online to www.tafp.org or call (512) 329-8666 x 36. On-site registration will be available, but we encourage you to save your spot today!

TMHP to host March conference calls on PCCM

The Texas Medicaid and Healthcare Partnership has scheduled three conference calls to address questions about the expansion of Primary Care Case Management. The calls will take place from noon to 1 p.m. on March 1, March 8 and March 15.

Since last fall's expansion of the PCCM Medicaid delivery system to 197 of Texas' rural and border counties, confusion about the program has mounted among providers.

To participate in an upcoming conference call, contact TMHP with your name, telephone number and nine-digit Texas Provider Identification number. Slots for the call vary between 50 and 75 participants and will be filled on a first-come, first-served basis. Additional questions can be directed to TMHP at (800) 925-9126.

March 1, 2006 -- Call in number (800) 473-8796, 12 - 1 p.m.
Confirmation No. 47545210

March 8, 2006 -- Call in number (800) 473-8796, 12 - 1 p.m.
Confirmation No. 47545229

March 15, 2006 -- Call in number (800) 659-6183, 12 - 1 p.m.
Confirmation No. 47545236

Resources:

Unsure of which border and rural counties have been added? Take a look at TMHP's list.

Read the PCCM Q&A from fall 2005's TEXAS FAMILY PHYSICIAN.

Won't you help your neighbor?

Physicians asked to help in New Orleans

Texas family physicians are being called to help out their neighbors in Louisiana by giving their time and expertise to victims of Hurricane Katrina. The project, sponsored by Heart to Heart International, will take physicians into the wounded New Orleans area to staff short-handed health clinics. Weeklong commitments are preferred, but any help is appreciated. Travel, food and lodging are provided by Heart to Heart.

Don't worry if you don't have a license to practice in Louisiana, the state-mandated emergency rule allows licensed physicians and other health professionals to serve the area. Medical liability is covered under the Good Samaritan clause. Heart to Heart International is a global humanitarian organization founded by family physician Gary Morsch, M.D. The organization serves the needs of the poor and around the world through partnerships and individual contributions. If you are interested in serving in the New Orleans area, contact Steve Hower by phone at (816) 223-0949 or electronically at steve.hower@hearttoheart.org. Visit Heart to Heart’s Web site for more information on this project or others, www.hearttoheart.org.

AHA/ASA: Stroke survivors not out of the woods yet

Almost a third of the estimated 700,000 strokes that occur each year in the United States are recurrent strokes, making a second stoke or transient ischemic attack (TIA) the greatest threat to stroke or TIA survivors.

This conclusion comes from the American Heart Association/American Stroke Association's recently published "guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack." In the report, which appears in "Stroke: Journal of the American Heart Association," the organizations put forth a number of recommendations to prevent a second stroke or "mini-stroke."

To reduce the risk of a stroke, patients can decrease modifiable risk factors such as eliminating smoking, limiting alcohol, reducing obesity and boosting physical activity. They can also utilize medical options through their physicians such as anticoagulants and antiplatelet agents, or undergo interventional procedures such as carotid artery surgery or angioplasty.

Other updates within the guidelines increase the severity of stroke prevention awareness in certain populations: the aging baby boomers, pregnant or menopausal women and ethnic minorities. Ralph L. Sacco, M.D., M.S., estimates the occurrence of strokes to rise to over 1 million by 2050, making the most significant increases in these groups. Sacco is the chairman of the ASA's Stroke Advisory Board and chairman of the ASA's Secondary Stroke Prevention Guidelines Committee.

Resources:

Access the complete report.

To view the press release, visit the American Heart Association's press room.

NEW FOR YOU: Log your health plan complaints online

AAFP recently launched an online health plan complaint form for members to report insurance company hassles. Since the form is Academy-directed, all of the information submitted will help the Academy better represent your needs.

Read AAFP's article on the form.

Copyright 2006, Texas Academy of Family Physicians