Magazine article Drug Topics

Consumers Should Beware of Part D Pitfalls, Warns Expert

Magazine article Drug Topics

Consumers Should Beware of Part D Pitfalls, Warns Expert

Article excerpt

Medicare Part D is still not for wimps, be they health professionals or consumers, any more than it was in early 2006, according to a Kaiser Family Foundation (KFF) analyst. Indeed, mere is high risk that many beneficiaries are getting into plans, both for 2006 and 2007, that are not good for covering their medications and there could be health consequences, said Patricia Neuman, ScD., director of the foundation's Medicare Policy Project.

Noting the good news that most Medicare beneficiaries do have some form of prescription coverage and that Medicare's Web site offers good information, she nevertheless warned that Part D is a system "predicated on the assumption that people will make good decisions to get the drugs that they need at the best possible costs."

Almost 25% of all beneficiaries are enrolled for 2006 in one of two plans, with AARP MedicareRx having 14% of all enrollees, said Neuman, who spoke at the recent annual meeting of the Pharmacy & Therapeutics Society in Washington, D.C. She said she suspects that, rather than doing comprehensive research, many beneficiaries simply went for a low premium or with a name they trust.

Neuman emphasized that 27% of Medicare beneficiaries have cognitive impairments and 25% have never gone on-line. And plan choice makes a big difference, because plans vary in benefit design, formularies, tiering, and cost-sharing amounts. And some people, she warned, may be in serious trouble. For example, for one beneficiary she helped, the difference between the best and the worst plans was about $8,000.

KFF analysts now believe that three or four million people covered by Part D will spend themselves into the "donut hole," or the coverage gap, in 2006, said Neuman, pointing to research indicating many people are noncompliant with medications when their plans don't pay for them, resulting in hospitalizations and emergency room visits.

Noting, for example, that the plans cover 91% of all beta-blockers but only 70% of cholesterol agents, Neuman said: "That may not be a bad thing. I'm not casting judgment. But if you take a medicine that isn't covered, it's clearly an issue at the individual level." She noted that 51% of pharmacists said that most of their patients' formularies lack sufficient coverage, according to a KFF poll in April through June. …

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