Medicare Part D

[rex_b]

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Do you , as pharmacists, think Medicare D is a good program or not? Do they cover most drugs and actually help people? Where are the holes and how could they be helped?

What is your general concensus on the whole program?


Rex

 

[sdn1977]

My gosh rex!!!!!! Wasn't your dinner in the oven? Last time I was in a focus group, I was paid & fed a wonderful brunch. So, really, who do you work for? A PBM or a political person? I'd be happy to give you my thoughts - especially since I can be a bit anynomous. But...I'd like to know where you're coming from.

 

[rex_b]

Haha. Funny. Actually currently I'm unemployed. Well not technically unemployed since I do other things for hobby income. For example I run cruiselineforums.com and a few other smaller forums. I don't work for a PBM and am not political, well I have issues with politicians if that counts! lol

Just curious since I couldn't ask these questions at my last job. 🙂

 

[sdn1977]

Haha. Funny. Actually currently I'm unemployed. Well not technically unemployed since I do other things for hobby income. For example I run cruiselineforums.com and a few other smaller forums. I don't work for a PBM and am not political, well I have issues with politicians if that counts! lol

Just curious since I couldn't ask these questions at my last job. 🙂

ok....I'll answer your question. But, I'm not surprised at why you couldn't ask these in your last job!

To start with the last - I have an unfavorable opinion on the current Part D program & I feel it will need to undergo a major overhaul before it becomes a good program.

To go back to the beginning though, I feel the program was designed with good intent, altho the actual manner and method was poorly implemented.

The holes are far too many to go into on a message board, IMO. I feel the current administration has caused irreparable harm with the profession of pharmacy, so I don't feel it will ever be improved until the political climate changes. The negative undercurrents have caused those who are eligible to suffer since everyone will not come to the table any longer to discuss what needs to change.

 

[WVUPharm2007]

The holes are far too many to go into on a message board, IMO. I feel the current administration has caused irreparable harm with the profession of pharmacy, so I don't feel it will ever be improved until the political climate changes. The negative undercurrents have caused those who are eligible to suffer since everyone will not come to the table any longer to discuss what needs to change.

I'd tend to agree with this. But nothing will ever be fixed. Even if the idiot Republicans are put out of office, you have a bunch of idiots called Democrats that would take their place by default. What would they do any different? Every president and administration for the last quarter century has been a bloody incompetent fiscal and social services manager. Why would anything change now?

I'm going to start my own political party. To hell with everyone.

Also, why the hell is part D farmed out to 3rd parties? There is no point other than to line the pockets of huge insurance companies or maybe they wanted to start a program that would increase the pharmacist suicide rate because we hate the world so much.

 

[sdn1977]

I'd tend to agree with this. But nothing will ever be fixed. Even if the idiot Republicans are put out of office, you have a bunch of idiots called Democrats that would take their place by default. What would they do any different? Every president and administration for the last quarter century has been a bloody incompetent fiscal and social services manager. Why would anything change now?

I'm going to start my own political party. To hell with everyone.

Also, why the hell is part D farmed out to 3rd parties? There is no point other than to line the pockets of huge insurance companies or maybe they wanted to start a program that would increase the pharmacist suicide rate because we hate the world so much.

Ok - a couple of things....I have faith the system can be fixed - now will it - who knows! But...the reason I spoke about this administration was not from a democrat/republican standpoint, but because the President came right out and said pharmacists were the enemy (I think those were his exact words - I'd have to go back..). It wouldn't matter to me what party he was a member of - this particular person speaks before he thinks. Saying that to anyone - even if he is the porter who mops when the foley catheter leaks is offensive and not conducive to constructive argument!

Now...I do think there are those within the system who feel a nationwide consolidation & unification of benefits might be worthwhile. It will be a long time before this is put into play, but discussion is beneficial.

The reason it was given to the third parties is practical - they have the structure in place to make it happen. I remember when the interns & clerks (before technicians were even an entity) - but most of you anyway! actually typed manual claims, folded, stuffed envelopes, stamped & mailed the claim. Then we waited 90 days...then sent clarification, finally the claim was paid after 180 days. - You don't want to go backwards! This computer, online, realtime system is so much better, but its expensive. Why reinvent the wheel when its already there?

But...we need to get a discussion going between those folks who won't call each other names or try to place blame on a system which is modern, sophisticated, accessible & the best in the world! We want to be part of the solution - not part of the problem which is why you don't see the pharmacy leaders lashing back!

 

[WVUPharm2007]

Ok - a couple of things....I have faith the system can be fixed - now will it - who knows! But...the reason I spoke about this administration was not from a democrat/republican standpoint, but because the President came right out and said pharmacists were the enemy (I think those were his exact words - I'd have to go back..). It wouldn't matter to me what party he was a member of - this particular person speaks before he thinks. Saying that to anyone - even if he is the porter who mops when the foley catheter leaks is offensive and not conducive to constructive argument!

Holy crap, did the little bastard ACTUALLY say that? I want a quote.

Now...I do think there are those within the system who feel a nationwide consolidation & unification of benefits might be worthwhile. It will be a long time before this is put into play, but discussion is beneficial.

The reason it was given to the third parties is practical - they have the structure in place to make it happen. I remember when the interns & clerks (before technicians were even an entity) - but most of you anyway! actually typed manual claims, folded, stuffed envelopes, stamped & mailed the claim. Then we waited 90 days...then sent clarification, finally the claim was paid after 180 days. - You don't want to go backwards! This computer, online, realtime system is so much better, but its expensive. Why reinvent the wheel when its already there?

Why couldn't the government use the same backbone they use to bill part B for diabetes testing supplies? It is instant. The backbone is already there, isn't it?

But...we need to get a discussion going between those folks who won't call each other names or try to place blame on a system which is modern, sophisticated, accessible & the best in the world! We want to be part of the solution - not part of the problem which is why you don't see the pharmacy leaders lashing back!

I'd tend to agree, I guess, in theory. But we are in a politically conflictive country. Everyone wants to be a member of one of the two meta-groups and then prove that the other group is evil. It's a greasy wheel time of thing.

 

[sdn1977]

Mybad...sorry! The actual quote:

"It's not immoral to make sure that prescription drug pharmacists don't overcharge the system" G. Bush Feb 8 Manchester NH

This was made in response to critics who felt that the Medicaid cuts which were signed into law & the Medicaid cuts suggested for 2007 are immoral.

Pharmacists from all over the country objected to the statement that we overcharge patients & each states pharmacy organizations as well as other health care providers requested a letter of apology to pharmacists for implying we gouge patients. Bush has never apologized & it is very clear he has no idea what part pharmacy plays in the whole of the health care system.

Many states lawmakers & health professionals have stated many times since that we have no discretion in how much to charge patients under Medicare & Medicaid - these rates are determined at the federal & state levels, not at individual pharmacy levels.

This was reported in most major newspapers as well as online news services, so you can read the full report - google bush, pharmacy, manchester. There have been many articles since on how poorly the Part D implementation has been handled.

 

[sdn1977]

WVU - for your questions with regard to third parties & the structural backbone. Yes - Medicare Part B has the ability to process diabetic supplies, but again, I may be mistaken since that is done corporately in my situation....it is tied to an ICD9 code - a diagnosis. Also, there are very few line items - seems like a lot of strips & lancets, but compare that to all the different ACE inhibitors/combinations & all the diuretics, etc just for htn alone - lots & lots & lots! You also don't have simple ICD9 codes - propranolol can be used for htn, migraines, performance anxiety, arrhythmias - now you have multiple combinations (a math major could work out all the permutations....or is it combinations - whatever!)

Then...and most significantly, I think...is the history of Part D. I think it started during the Clinton administration & talk of universal health care. Well - that was for everyone, not just SSI eligible folks - & that was bungled as well. But...the one thing that did come out of that discussion was in this country, people were not ready for universal (they also used "socialized" rightly or wrongly in its place) health care. So...they wanted to maintain the "image" of a privately sponsored plan. So, the third parties were very ready to leap onto this bandwagon because they had such experience in claims processsing - for a PRICE!

Now...this might have been implemented ok, but it was done way too fast - both for pharmacies & for patients. The publications were poorly done & written at a level too high for a signficant number of the eligible folks to understand. The written material sent out to eligibles was not on a consistent font - like it should look if it were coming from Medicare. Each third party had its own font & paper, so much of it was discarded during the holiday time as throw-away stuff because these folks didn't know they were going to be hearing from ScriptSave - they were waiting for Medicare Part D!

I could go on and on, but won't belabor it. The whole thing has turned out to be a huge mess & won't be sorted out until the entire healthcare system is reshuffled (my opinion!). I don't think it matters who you vote for - they don't understand us as professionals & they surely won't understand you as a patient, especially when you get old!!! They just want your money (ooop-vote)