Surveys show most pharmacists, doctors believe Medicare Drug Benefit helps patients, though most think it is too complicated

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Sep 11 2006

Most pharmacists and physicians believe that the Medicare prescription drug benefit has helped beneficiaries save money on their medications but also believe that the program is overly complex, according to two surveys released on Thursday by the Kaiser Family Foundation, the San Francisco Chronicle reports (Colliver, San Francisco Chronicle, 9/8).

The surveys, conducted from April through July, include responses from 802 pharmacists and 834 physicians. According to the surveys, 86% of pharmacists and 71% of physicians believe that the Medicare prescription drug benefit has produced savings on medications for beneficiaries (Wisenberg Brin, Dow Jones, 9/7). The surveys also find:

53% of pharmacists and 27% of physicians believe that the Medicare prescription drug benefit has caused "a lot" of administrative burdens (San Francisco Chronicle, 9/8);
53% of pharmacists and 46% of physicians with patients enrolled in Medicare prescription drug plans believe that the plans have more administrative burdens than commercial health plans;
27% of independent pharmacists say they have had to take out a loan or line of credit because of cash-flow problems related to the Medicare benefit;
Eight in 10 pharmacists said they have had customers that experienced problems with access to medications under the Medicare prescription drug benefit, and one in five said that such problems affected "most" customers;
45% of pharmacists who serve dual eligibles -- beneficiaries whose prescription drug coverage was transferred from Medicaid to Medicare when the prescription drug benefit began -- said that those customers experienced more problems with access to medications than other Medicare beneficiaries (Kaiser Family Foundation release, 9/7);
Two in three pharmacists said that customers have left their pharmacies without medications because the treatments did not appear on the formularies of their Medicare prescription drug plans, and nearly six in 10 pharmacists said that customers have paid for treatments out of pocket because they could not verify their enrollment in plans (Carey, CQ HealthBeat, 9/7);
About half of pharmacists said that customers have left their pharmacies without medications because they could not afford copayments (Kaiser Family Foundation release, 9/7);
59% of physicians with patients enrolled in Medicare prescription drug plans said that some of those patients have experienced problems with access to medications, and 15% said that such problems affected "most" of their patients;
One in 10 physicians said they have had a patient experience "serious medical consequences" as a result of problems with access to medications under the Medicare prescription drug benefit (CQ HealthBeat, 9/7);
69% of physicians said that they are not familiar with Medicare prescription drug plan formularies, and 59% said that they rarely or never review formularies before they prescribe medications to beneficiaries; and
85% of pharmacists and 57% of physicians believe that they have "a lot" or "some" responsibility to advise seniors about the Medicare prescription drug benefit (San Francisco Chronicle, 9/8).

Drew Altman, president and CEO of the Kaiser Family Foundation, in a statement said, "We have surveyed seniors many times, and now pharmacists and doctors, and the story is remarkably consistent: The benefit is providing help to millions as intended, but there are also problems, and the complexity of the law is an issue for many" (Dow Jones, 9/7). Mollyann Brodie, a Kaiser Family Foundation vice president and director of the Public Opinion and Media Research program at the foundation, said, "While seniors might expect their doctor to know when a prescription is covered by their Medicare plan, that's generally not how it seems to be working." She added, "Seniors may not find out until they show up at the pharmacy" (Kaiser Family Foundation release, 9/7).

Reaction

Jeff Nelligan, director of media affairs at CMS, in a statement said that the surveys "confirm that the agency's efforts with respect to outreach and education have been very successful." Nelligan added that the surveys "do acknowledge some challenges with reimbursement and beneficiary confusion in the early days of the benefit, pharmacists on the whole speak positively (and objectively) about Part D in terms of how well it is serving their customers." CMS had worked with Medicare prescription drug plans "to streamline the appeals, exceptions and prior authorization processes to further minimize any burdens perceived by physicians," he said. Karen Ignagni, president and CEO of America's Health Insurance Plans, said that the surveys provide "a strong validation" of the Medicare prescription drug benefit, adding, "The bottom line is this program is working for beneficiaries" (CQ HealthBeat, 9/7). Michael Negrete, vice president of professional affairs for the California Pharmacists Association, said, "If there's any trouble anywhere along the line related to the administration of the Part D benefit, where it hits the fan, it's at the pharmacy," adding that pharmacists spend a significant amount of time on efforts to help customers with the program (San Francisco Chronicle, 9/8). Rep. Pete Stark (D-Calif.) said, "Though you wouldn't know it from several months of glowing media accounts, seniors and people with disabilities across America continue to struggle with a program that is unnecessarily complex and with private plans that do not cover the drugs they need" (CQ HealthBeat, 9/7).

The surveys are available online.

Social Security Check Deductions

In related news, the federal government will encourage Medicare beneficiaries who enroll in the prescription drug benefit for 2007 to pay prescription drug plan premiums directly rather than have premiums deducted from their Social Security checks, the AP/Wall Street Journal reports. Thousands of Medicare beneficiaries have experienced problems with the payment process this year, most recently when more than 230,000 beneficiaries were erroneously reimbursed for their premiums last month (AP/Wall Street Journal, 9/7). The Medicare prescription drug benefit enrollment period for 2007 begins on Nov. 15. At a closed hearing of the Senate Finance Committee on Thursday, CMS Administrator Mark McClellan said that the agency has worked with the Social Security Administration to address problems with data transfer between the two agencies. SSA Commissioner Jo Anne Barnhart also testified at the hearing. After the hearing, committee Chair Chuck Grassley (R-Iowa) said that CMS and SSA have "demonstrated a good-faith effort to solve those problems, but they also do not have all of the cases taken care of, and they are working on getting that done." He added, "I think we're working things out" (CQ HealthBeat, 9/7). Sen. Max Baucus (D-Mont.), ranking member of the committee, said, "I expect more problems like this down the road," adding that the Medicare prescription drug benefit is "unnecessarily complicated" (Lee, CongressDaily, 9/8). On Thursday, Baucus sent a letter to McClellan and Barnhart that said CMS and SSA "need to work together to better control data file exchanges, so that quality checks, not just eligibility edits, are performed on both sides." He added, "Congress should be consulted before you fix errors, particularly those involving beneficiaries" (CQ HealthBeat, 9/7).

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.