Drug card complexity stalls use

Thursday, June 3, 2004 | 12:00 a.m. CDT; updated 7:32 a.m. CDT, Friday, July 18, 2008

Despite the Tuesday start date for Medicare’s new prescription drug discount-card program, area pharmacists say complexity, cost and processing delays seem to be discouraging people from using it.

“The whole program is kind of a bust,” said Jim Reid, a pharmacist at The Medicine Shoppe. “It’s too complicated to start out with. We’ve only had three to five inquiries about what’s available. Anyone with any kind of health insurance is better off using their insurance than the card.”

Gina Henry, manager of Kilgore’s Medical Pharmacy, said most of her customers have decided it’s not worth signing up for the discount cards.

“By the time people pay for the card, they may not see any savings, especially if they already receive our senior citizen discount,” Henry said.

More than 35 discount card plans are available to the 15,000 eligible Boone County residents. Before they apply for the card, participants must determine which plan covers all or most of the drugs they take. Some companies charge up to $30 a year for their discount cards. Although participants can receive discounts for only six months in 2004, they are required to pay the full annual fee for the card again at the beginning of 2005.

The discount card can save Medicare recipients up to 25 percent on prescription drugs, and low-income cardholders are eligible for a $600 tax credit per year.

Enrollment for the new card began May 3. It takes about a week for enrollments to be processed, and participants must wait to use the card until the month after they receive them.

Unlike other area pharmacies, D&H Prescription Drug Store has been flooded with inquiries since the beginning of May.

“One employee spends 40 hours a week just answering questions,” D&H pharmacist Blaine Alberty said. “The phones ring all day long, and we don’t anticipate any slowdown for the next few weeks.”

Questions tend to be about cost and the availability of different drugs.

“Our biggest focus for the last month has been to help people wade through all of the options out there,” Alberty said.

While some pharmacists and beneficiaries might view the number of choices as overwhelming, there are positive aspects to the wealth of options, said Denise Clemonds, executive director of the Missouri Association of Homes for the Aging. The agency represents nonprofit providers of services to senior citizens.

“With the rising cost of health care, this is a way for the federal government to save money for Medicare beneficiaries,” Clemonds said. “This program will help increase choice and increase competition among drug providers.”

Not only must participants choose from a variety of plans, but pharmacies must also apply to offer the discounts to Medicare recipients. Cardholders cannot expect to walk into any pharmacy and receive a discount.

“We sign up for cards we’re willing to offer through our store. We must determine if it will be profitable for us to participate,” Alberty said. “We’ve signed up for most of the plans.”

Osco Drug and The Medicine Shoppe received directives from their corporate offices regarding which cards they can honor. “We’re taking about 95 percent of the cards,” said Osco pharmacist Kurt Morgan.

The discount cards last for one year. If cardholders are unhappy with their plan, they have a chance to change between Nov. 15 and Dec. 31. Medicare recipients who also receive Medicaid outpatient prescription drug coverage are ineligible for the new cards.

In 2006, the federal government will replace the discount cards with an expanded prescription drug plan. “It will be more like an insurance program with co-pays and deductibles,” Clemonds said.

Marie McCuistiom, a resident of Tiger Columns, estimates she spends $10,000 a year on 20 prescription drugs. While her insurance covers $2,500, she pays the balance.

“I would like to learn more about the card and the different companies,” McCuistiom said. “I’ll have to see how much studying I can do.”

The discount cards might not be the cheapest way for Medicare participants to get drugs. Alberty said pharmacy benefit managers, who provide the discount cards and negotiate between the government and pharmaceutical companies, incur unnecessary costs.

“PBMs are responsible to their shareholders rather than to patients,” Alberty said. “There’s no transparency. This is a highly unregulated industry.”

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