HJ/EDHerald Journal / Enterprise Dispatch Jan. 16, 2006

Medicare D: more questions than answers

By Dave Cox
Staff Writer

The new Medicare D prescription drug program is off to a rocky start according to one local pharmacist.

“It would be easier to jump a wheelchair over the Grand Canyon than to work with this plan right now,” Pharmacist Kelly Keaveny said.

Keaveny is not new to the business. He is a third-generation pharmacist, and owns pharmacies in Cokato, Annandale, and Winsted.

Keaveny said he has spent hours on the phone trying to get answers from Medicare prescription drug plan providers.

“It seems like they are starting to make decisions based on the questions we are asking. This has been a nightmare, even for physicians,” Keaveny said.

Medicare D has been described as an optional program, but Keaveny called it an “optional mandatory program,” because there is a 1 percent per month penalty for those who do not enroll in an approved plan by May 15.

Keaveny explained that there are 14 plans that are available in Minnesota, but some pharmacies are not currently accepting all of these plans.

Keaveny also said that among the 14 plans available in the state, there are both regional and national plans. Some people, such as those who go south for the winter, might want to look at a national plan so that they will be covered at their winter homes.

The regional plans cover Minnesota, North Dakota, South Dakota, Iowa, and Wisconsin.

There are two main factors that should be considered when choosing a plan, according to Keaveny.

How much will you spend?

The first consideration is the cost of prescriptions you are currently using.

Keaveny said you should look at your total drug charges for last year, not just your out-of-pocket costs.

This will help you determine if you should enroll in one of the basic plans, or one of the other plans.

If your total drug costs were between $1,600 and $2,000 last year, you are probably safe to go with one of the basic plans, which have premiums that generally range from $13 to $30,” Keaveny said. Those with higher drug costs might be better off with one of the plans that have higher premiums, but more comprehensive coverage.

The reason for this, according to Keaveny, is that some plans have a gap in coverage.

Under these plans, after the deductible has been paid, the plan will provide coverage until the total cost of prescription drugs reaches $2,250.

Then, there is a gap, where the consumer pays 100 percent of the cost, until the total reaches $3,600.

Once the total reaches $3,600, the plan will again pay a portion of the cost.

Some of the plans with higher premiums provide limited coverage even during the gap, which makes it easier for consumers with high drug costs to budget their prescription drug expenses.

Some people have questioned if they would save money by buying prescription drugs from Canada.

“This (Medicare D) should put us in line with Canadian pricing. You should not have to drive to Canada,” Keaveny said.

Keaveny also cautioned that drugs purchased from outside the US, even those purchased from Canada, may have been made in third-world countries, without any controls.

He related an example of a customer that asked for “generic Lipitor.” Keaveny told the customer that there was no such thing, and that a generic version of Lipitor would not be available for six years.

The customer told Keaveny that he had purchased some “generic Lipitor” from another source, and showed him the bottle.

It turned out that the drug in question had been made in Afghanistan.

Keaveny said that the advantage of purchasing drugs made in the US is that they are manufactured under the strict control of the FDA.

Which drugs are covered?

Another major consideration is the drugs covered by each plan. Keaveny advises that if you are deciding which plan to enroll in, you should request a formulary from whatever plan you are considering, and bring this to your doctor to make sure the drugs you need are covered by the plan.

All plans are only required to cover two drugs from each disease class, Keaveny said, so you need to check the formulary to see if a plan covers a drug you are using.

Another hurdle that Keaveny has seen with the Medicare D program is that some drugs that are medically necessary are not covered by some plans.

May 15 is the deadline to enroll in a Medicare D approved prescription drug plan. After that, the next open enrollment period will be Nov. 1 to Dec. 31.

If your Medicare D plan is cancelled by the provider, you can change to another Medicare D plan without penalty.

The Medicare D program appears to be evolving, and it may take some time before all of the questions have been answered.

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