Medicare Part D — WTF?

Posted by The *Angriest* Pharmacist as Drug Companies

I received this email through the pharmacist-grape vine.

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From:[Contact TheAngriestPharmacist for Sender's Email]
To: rick.larsen@mail.house.gov
Subject: Medicare Part D Merry Go Round 2008
Date: Wed, 28 Nov 2007 22:57:54 -0800

11/28/2007

Representative Rick Larsen
United States House of Representatives
1529 Longworth House Office Building
Washington, DC 20515

Dear Rick:

From time to time you have been able to stop in our pharmacy when on
Lopez Island and I always felt you listened to our concerns about health
care. I thought I’d share with you what I call the Medicare Part D
Merry-Go-Round. Each year the Medicare patient must reevaluate their
respective Medicare Part D drug plan, only because the coverage that they
had during the current year can and does change each year.

Plans have low balled premiums only to raise them in latter years
with the hope that most Medicare patients won’t change their plan. If they
don’t raise their premium they change what they cover. If that isn’t enough
the plans then still covers their drugs, but then changes the copays, or
other criteria for their drugs. This is a unbelievable complicated system
for our seniors. We try to help our patients make sense of the changes, and
when we can we provide education to them to show what their plan was, is or
will be. Again most of the plans are betting that the patient will not
change plans.

I’ve got a good grasp on the system and it takes me hours to
evaluate the plans, can you imagine how a Medicare patient that isn’t
computer savvy feels? This system needs to be fixed and fixed now. Think
about these common sense ideas.

1. Make a fixed list of drugs that are covered for a basic, premium and
deluxe plan.
2. Make copays fixed for generics and brand name.
3. Get the rebates that are lining the pockets of the managers of these
plans into the patients pocket by getting rid of the donut hole.
4. Let the PBM’s make their money by being claims processors, not slight of
hand artists in hiding their rebate dollars.
5. Remove the self-referrals that the PBM’s are making by steering the
Medicare patient into their own mail order pharmacies.
6. We need to allow medications to stand on their own two feet for their
effectiveness, not how many TV ads that can generate.
These direct to consumer ads are adding huge amounts to the cost of
prescriptions in this country. We all know that more dollars are spent on
promotions than on research.
7. Finally make one plan ran by Medicare itself, not by the private plans.

Our elected officials have the power to change this system and it
must be changed. What is important is getting quality care to our seniors.

Respectfully,

Richard C.McCoy,Jr.R.Ph.
Lopez Island Pharmacy
Lopez Island, WA 98261
360-468-#### x103 [Contact TheAngriestPharmacist for Phone Number]

***Reproduction and publication rights are granted on this letter to any
group or individual ***

I think Mr. McCoy has hit the nail on the head. The Federal Government conceded the fact they they could not handle adequately implementing Medicare Part D, so they allowed the insurance companies to step in and take a crack at it. Much as we would have expected, the PBMs have concerned themselves with their pockets and not with the welfare of our seniors/recipients.

I’ve said for a long ass time that direct-to-consumer advertising needs to be made illegal. The average American cannot be expected to comprehend the many factors that go into prescribing. And the fact that Pharma sidesteps the law by merely stating, “Ask your doctor about DrugX” really pisses me off. If they do not state the indication, they do not have to specify the potentially dangerous (and common) side effects. Another practice Pharma has resorted to is that of completely ignoring the law. Throw together a commercial. Get it on the airwaves quickly and widespread — then watch the profits roll in. They may be breaking the law, but by the time complaints can be registered and the FDA can get an injunction (they don’t have any real power) Big Pharma has already seen profits well above potential fines they may incur. That’s fucking bullshit isn’t it?

Don’t even let me get started about what Part D’s reimbursements have done to the independents. These guys are fighting tooth and nail to stay afloat. They don’t have a 200 thousand square foot store to account for losses incurred to balance things out.

Rick has also nailed the complexity of the plans. If I have to struggle to comprehend the assorted plans, I can’t imagine what our country’s seniors are thinking. This has created a viscious cycle. Pharmacists don’t have time to learn the plans and/or help the people due to the increased volume generated by the number of people covered and the decreasing number of pharmacies.

I’m pissed off — how about you?

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