Pharmacists, seniors hope 2007 is better year for Medicare Part D

For Gordon Kost, the prescription drug coverage for seniors known as Medicare Part D hasn’t been the panacea it was touted to be when it was passed by Congress in 2003.

During 2006, its first year on the books, the new law was expensive in terms of money and headaches for Kost, an independent pharmacist who owns Goose Creek Pharmacy in Boulder.

He’s hoping to fare better in 2007.

“Last year at this time people didn’t know what plan they were on. People would come to the pharmacy window, on one of the dozens of plans, and didn’t know what plan they were on, but were expecting their drug purchases to be covered under Medicare,” Kost said. “The pharmacy was put in the position of either giving them drugs for free or denying their medications.”

Kost, a self-described “one-man band,” filled the prescriptions for his customers, “under the assumption I would eventually be able to figure out their plan and bill for their medication.”

He has been reimbursed for all but “a few thousand dollars,” he said.

Medicare officials agree that the kickoff year was difficult for everyone involved: Seniors and their families, pharmacists and those at the U.S. Department of Health and Human Services tasked with assisting them.

Three months into the second year of the program they say things are going much more smoothly.

“There were a lot of shakeout problems,” admitted Mike Fierberg, spokesman for the Denver regional branch of the Centers for Medicare and Medicaid Services, an agency under the department.

Complaints have gone down, and according to surveys of beneficiaries, “75 to 80 percent say they are ‘satisfied or very satisfied.’ “

Alice Ireley, a Medicare ombudsman with Boulder County Aging Services, said the number of calls to her department have decreased dramatically. During November and December 2005, the first two months of enrollment for 2006, she responded to 796 Part D issues. During the first two months in 2006, as seniors enrolled for 2007, she received 493 Part D phone calls.

One of the reasons for fewer problems this year is the various systems that need to communicate.
Medicare, Social Security Administration, drug plans and pharmacies, “are more frequently doing what they say they are going to do,” she said. “You’ve just multiplied by a factor of four how many parties have to be on the same page, let alone the consumer.”

Ireley said the biggest problem is consumer confusion. “It is a very complicated structure with a complicated set of choices for people to make.”

Each of Colorado’s 55 statewide Medicare Part D plans that cover only drugs, along with each county’s “Medicare Advantage” plans that combine health insurance and drug coverage, are negotiated independently.

“Who I’m going to get the best overall benefit from is going to depend on what drugs I’m taking,” Ireley said. “You may be in plan 23 because of your five drugs, but my five drugs kick me over onto a different plan. There’s no intuitive way to know that.”

That was what Connie Nelson faced when she signed up last year. Nelson, a 68-year-old retiree from Columbus, Ohio who moved to Boulder to be closer to her daughter and grandchildren, didn’t sign up for Part D the first year. “I don’t take that much medicine,” she said. “I thought I was being penalized for being healthy.”

Then her daughter was diagnosed with breast cancer. With no history of the disease in her family – including eight sisters – Nelson became alarmed at what could happen if she didn’t have a prescription drug plan.

Nelson, a former health-insurance professional, called Medicare directly to figure out which plan was right. A search of the Medicare database, which is available online at www.medicare.gov/pdphome.asp, indicated the drug-only Humana Standard plan was best for her. At $16.60 per month with a $265 per year deductible and a co-pay of 25 percent per prescription, the plan is the least expensive in the state.

Humana also offers the most expensive drug-only plan in the state – its Complete plan costs $83.30 per month and has no deductible; the co-pay may be $5, $30, $60 or 25 percent of the drug cost depending on the prescription.

The plan saves Nelson $250 a year, “which isn’t a lot, but it’s something,” she said.

Medicare Part D

Plan definition
Medicare Part D is a prescription drug plan for anyone 65 or older regardless of income, health or prescription drug plan. Providers may change what drugs they cover, monthly premium, deductible or co-pay, so Medicare professionals advise examining your plan every year.

Colorado offers 55 Boulder County drug-only plans, and each county offers its own plans, known as Medicare Advantage, that combine health insurance and drug coverage. Boulder County has 16 Medicare Advantage plans, and Broomfield County has 15.

Drug-only plans: $16.60 to $83.30 per month; deductibles range from zero to $265 per year.
Combination plans: zero to $78.80 per month; deductibles between zero and $100 per year.
After the deductible is met, a co-pay is required that varies – depending on the plan – between a fixed price and a percentage of the prescription, until $2,400 in out-of-pocket expenses are reached. Then, in many plans, a “coverage gap” begins, and individuals are responsible for 100 percent of drug costs. Other plans include extra coverage during the gap. In either case, once individuals spend $5,451.25 in total drug costs for the year, they pay 5 percent of prescription costs for the rest of the year.

Enrollment
Number of people enrolled in Medicare Part D in Boulder and Broomfield counties:
Plan Boulder County Broomfield County
Drug-only plans 4,876 444
Combination plans 7,623 1,897
Medicaid eligible* 1,958 217
Total 14,457 2,558

* Some Medicaid recipients are eligible for Medicare. They could either be on drug-only or combination plans.
Source: Centers for Medicare and Medicaid Services

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