Part D Program Earns Overall Passing Grade

February 12, 2007
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The two groups of individuals closest to senior citizens and the Medicare Part D Drug Prescription Program reported they saw some real benefits in the new drug law for recipients. At the same time, though, the seniors' personal physicians and neighborhood pharmacists agreed overwhelmingly that the program was far too complicated.

Those yin-and-yang findings, along with many others, came from separate nationwide surveys of 834 physicians and 802 pharmacists conducted last summer by the Henry J. Kaiser Family Foundation, a private nonprofit organization that focuses on health care issues.

The surveys revealed that most physicians (71 percent) and pharmacists (86 percent) believed that Part D saved seniors money on their prescription costs. But an even greater number of doctors (92 percent) and a similar number of pharmacists (91 percent) thought the program was too complex, and most physicians (64 percent) and pharmacists (83 percent) agreed the program benefited private health plans and drug companies too much.

Furthermore, members of both professions reported that seniors had difficulty in getting their medications — problematic situations that sometimes had serious consequences.

"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," said Kaiser Family Foundation President and CEO Drew Altman.

Here are some of the findings from the pharmacists:

  • Eight in 10 (81 percent) had customers who had problems getting their prescriptions. One of five (19 percent) said the problem affected most of their customers in Medicare drug plans.

  • Two in three (67 percent) had customers leave the pharmacy without a medication because the drug was not on their plan's formulary.

  • Almost six in 10 (58 percent) had customers who paid out-of-pocket for their drugs because they could not verify their enrollment in a Medicare drug plan.

  • Nearly half (49 percent) said they had customers leave without getting their prescription filled because they could not afford the co-pay charged under the plan.

  • Nearly half (45 percent) said customers who previously got coverage from state Medicaid plans had more problems filling their prescriptions than any other Medicare customers.

Here are some of the findings from the physicians:

  • Almost six in 10 (59 percent) said patients had trouble getting their prescriptions filled under the drug plan.

  • Fifteen percent reported that "most" of their patients had that problem.

  • Ten percent had at least one patient who suffered a "serious medical consequence" as a result of that problem.

The surveys noted that most pharmacists (85 percent) and doctors (57 percent) felt they had "a lot of" or "some" responsibility to advise seniors about their Medicare drug plan.

Nearly 80 percent of pharmacists reported that they had already done that. Most (77 percent) had helped a senior decide whether to enroll in a plan, and most (75 percent) helped a senior figure out if a specific drug was covered by a plan.

Medicare recipients, however, weren't alone in having difficulties with the plan, as pharmacists and physicians have problems of their own from Part D.

More than half of the pharmacists (53 percent) said the Medicare program resulted in "a lot" of administrative burdens, and the same percentage said the Part D burdens were worse than the ones they've encountered with commercial plans.

More independent pharmacists, who often own the pharmacy (63 percent), reported more burdens than those who worked at a chain drug store (48 percent). More than a quarter of independents (27 percent) had to get a loan or a line of credit because of cash-flow problems related to the Medicare benefit. About three-quarters filled customer prescriptions without knowing whether they'd be paid.

Roughly one in four doctors said helping patients make decisions related to the program resulted in "a lot" of administrative burdens for them and their staffs. Just under half (46 percent) said the burdens associated with the Medicare plan were worse than the ones they've had from commercial insurers.

The surveys were conducted between April and July, just months after Part D went into effect for seniors enrolled in Medicare, and the results have a sampling error of plus or minus three percentage points.      HQX

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