Prescription Drug Benefit Primer

The biggest number of glitches were reported to be with dually eligible individuals who were automatically enrolled by Medicaid into a private Part D plan. On January 15, the White House ordered insurers to supply all beneficiaries in need with a 30-day supply of medication, no matter what.3 Federal officials said that this measure may be extended if necessary. Bill Vaughan, a health lobbyist and senior policy analyst at Washington, D.C.-based Consumers Union said, This will get better and the system will shake out.

Medicare Drug Plan Goes Forward

According to an article in the New England Journal of Medicine, There is already evidence that this market for prescription-drug plans is working, given the quality, cost, and range offerings.4 Authors Bach and McClellan point out that the average monthly premium, approximately $32, is lower than it was originally projected ($37); the costs to the government are approximately $15 less per month per beneficiary than was projected; and 49 states have at least one plan where the premium is $20 or less. Beneficiaries who take few prescription drugs are well served by the plans with closed formularies, where some drugs are excluded, resulting in lower premiums.

The authors also point out that competition has resulted in coverage options that are much better than those outlined in the standard benefit structure (see chart, below) in more than two-thirds of the prescription drug plans and the Medicare Advantage plans. As a result, plans are available with no deductible, with coverage for the donut hole, and with different levels of co-payments; beneficiaries can choose plans based upon their preferences and financial needs, using the government Web site www.medicare.gov or calling 1-800-Medicare.

It is likely that patients will turn to their physicians when deciding whether they should sign up for Medicare Part D. As a trusted source of information, physicians are in a position to review the patient’s medications and help to identify plans that cover these particular drugs or equivalent medications. In anticipation of this role, physicians may find the Formulary Finder at www.medicare.gov helpful in advising patients. Physicians can also stay informed by going to www.cms.hhs.gov/medicarereform/pdbma and checking the new information as it is added. There is a General Information link to the press releases, issue papers, fact sheets, and summaries of regulations. Physicians and other health care workers may participate in CMS Open Door Forums to learn more about Medicare Part D on the Web at www.cms.hhs.gov/opendoor . Fact sheets that explain Medicare’s new prescription drug coverage and help patients understand the new coverage are available there.