I work at a pharmacy association and have found that most of the problems with Medicare Part D are with eligibility and plan coverage. Without making this conversation too complicated, the major problem with eligibility is the persons information in the system is not showing up in real-time for the pharmacist. Therefore, the patient is saying they are covered under one particular plan; however, the pharmacy sees other plan information the system. Another problem is with plan coverage. There may be a drug that is not covered or requires prior authorization. If a drug is not covered and this is the first time the patient has been subscribed this medication, the patient can get a one-time fill until the doctor changes the medication to a drug on formulary. If on the other hand a prior authorization is required, the pharmacist/patient has to send a prior auth form to the physicians office and they have to complete it and send it to the pharmacy plan. This slows down the flow of production in the pharmacy.
Also, I heard about the messaging in the pharmacy being a problem.
You should speak to the pharmacist and ask them if they are experiencing any major problems. Right now is open enrollment until December 31st. Normally most of the problems occur during the first of the year, especially with the patients that have switched plans. Again, I can go on and on about this, but this is just a little information. Hope I didn't confuse you.
