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Medicare Part D sign-up brings questions, costs

The Medicare Part D sign-up period begins tomorrow and local help is gearing up for another season of hours of answering questions from concerned seniors.
Ray County Fellowship Center Director Julie Anderson said that she helped more than 200 area seniors in the plan’s first year. The Part D plan started in April of 2006. The sign-up period runs from Nov. 15 to Dec. 31. During this period, seniors can sign up for the plan or change plans. There are more than 40 plans offered in Missouri.
Most premiums are going up as well. Some seniors have said that thier monthly premuims are increasing by 60 to 85 percent from last year. A handful of plans have cheaper premiums.
Anderson said it can take hours just to help one senior determine which plan is right for them.
“I still don’t think I got enough information out like I would have liked to,” Anderson said. “It’s really a lengthy process but it’s worth it to them because they don’t know how to use a computer.”
Part D is a separate plan from Medicare Part A and B that deals only with prescription drug plans. All plans are different and have different monthly cost and front-end premiums. Most plans have an initial $250 deductible.
Many seniors seek help from people like Anderson or their pharmacist because there are so many plans and options to chose from. Each plan has a list of approved drugs, and seniors must find a plan that has the drugs they need.
Most small pharmacy owners in 2006 had complaints that they were spending most of their day on the phone with plan benefit managers. PBMs are the middle man between drug companies and health care providers.
Everett Thompson, owner of C & C Drug Store said he would spend six or seven hours a night on work that he would have to take home because he would spend most of his day on the phone with PBMs.
“The first year was horendous because it was new. The second year there was some diminishing,” Thompson said. “I had spent the whole day talking to one person after another to help them without stepping beyond the guidelines.”
Thompson said that health problems can be compounded by the regulations and the PBMs. He said many times a doctor will diagoise a patient and determine a certain drug that a patient may need. Thompson said he can be on the phone for hours with the PBM because the prescibed drug will show up as not on the approved list of drugs. He said the doctor will then spend time filling out paper work to get the patient’s drug added to the list. He said many times the person making the decisions about the drugs has no medical training at all.
“The patient has to deal with not having medicine for 2 or 3 days, while we wait for an unqualified person to decide whether or not the doctor’s opinion is good or not,” Thompson said.
The process isn’t just slow for the patient either. Payments to the small pharmacies can take months to arrive while vendors expect bills to be paid weekly. Some small pharmacies have been forced to take out business loans or just went out of business because payments are not coming in.
Economy Health Mart owner Rick Ridder said smaller stores like his have to get creative to keep the bills paid.
“Working with PBM has changed everything,” Ridder said. “It creates more work on our part and its a real inconvience for the patients. Our cash flow is slower, but that is something we have to overcome by making adjustments.”
Another major concern of the plans is the gap of coverage or “donut hole” that exist in all plans. Seniors pay a deducatable and monthly co-pay for drugs. Once expenses reach more than about $2,200, seniors pay for 100 percent of cost until another level is reached where coverage picks back up with a co-pay. Ridder said patients need to tell doctors that they need generic drugs prescribbed if available.
“Need to get the word out that the least expensive drugs delay the donut hole,” Ridder said. “They need to tell their doctors that they need generics.”
Thompson said they need to get rid of the donut hole all together. He said the formulas used to calculate the donut hole can be decieving.
“They never realize that they are going to hit a day where they will have the 100 percent issue to deal with,” Thompson said. “Then they’re thrown into this crisis where they have a month and a half to go before they get to a new coverage year. Don’t change gears in October and November bringing these people within a sudden finacial crisis.”
Thompson said that it can lead to seniors not getting medications or doing things to avoid having to have medication. He said it leads to patients not becoming well and more costs across the board.
“We often get into a place where the pateint isn’t getting the best medication for them or they go through therapy to avoid medication,” Thompson said. “We have pinched pennies over here and driven up costs in dollars over there when we should have been looking for a balance.”
Both men said that although the program has problems, it still has benefits for seniors.
“It’s a program that is not without weaknesses or flaws but a number of people have benefitted,” Thompson said.
Seniors who need help can contact Anderson or can get help through the Missouri CLAIM program at the Ray County Library. Call 816-776-6064 to set up an appointment with a trained volunteer.

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