How-To: Find the best Medicare Part D prescription drug plan (OnThePharm (Hanser)) by RJS

So we’re in the open enrollment period for Medicare Part D. It started on November 15, and it ends on December 31. I’ve been doing consulting twice a week, and the scramble is in full effect. While I do quite a bit more than plunk in drugs and quantities for my consulting, there is one tool that is the backbone of what I do when running various scenarios. It’s the Medicare.gov plan finder.

This guide does not apply if you have a hybrid medicaid-medicare plan through your state. Those folks know who they are, and if you have no idea what I’m talking about, you don’t need to worry about it.

Before you begin you’ll need three things:

1. A complete drug list of the person you’re doing the research for. This means you’ll need drug names, strengths, and quantities. Calculations are done for a 30-day supply, so if you take something 3 times a day, the quantity for 30 days will be 90.
2. About five minutes
3. An Internet connection (har har)

Here’s a walk-through, so you’ll want to open the link in a new window or tab…

Click on “Find & Compare Plans” which brings you to this:

Click “Begin Personalized Search” which will bring you to this next screen. You will want to click where it says “click here.” Do NOT click the Continue button. This might trigger a browser prompt asking you if you want to continue sending this information over an unsecured connection. You’re not actually sending any information about yourself, so click Continue.

That brings you to this page:

You’ll want to mimic what I’ve done: put in the zip code of the person who you’re doing the search for, ignore the age range and health status, and then select “No” for all three of the next questions. They have no bearing on choosing the Part D plan for the average person. Click “Continue” at the bottom.

That brings you to this. Click the “Continue” button. (Top or bottom doesn’t matter.)

Get out that drug list that you put together. Click “Enter My Drugs” on this screen:

That brings you to this screen, where you can begin typing what drugs you take. I’ll fill in a couple of examples that someone might take, and run you through a couple of screens that you might run into.

So here’s my list for Bob Smith. Click “Continue” at the bottom when you are done filling in the drug names:

The next screen allows you to adjust the strength and monthly quantity. Go through the list of drugs on the left and change the strengths to reflect the drugs that you use before you start changing the quantities. Each time you select a strength other than the default, the page reloads, and you may lose any changes that you’ve made to the quantity. I learned this the hard way.

This next screenshot is the default, and the one after that reflects the changes I’ve made. Click Continue when you’re finished.

The next step is optional. You can choose a Password Date that allows you to save your drug and location information and pharmacy preferences. That means that when 2009 rolls around, you can more quickly retrieve your drug list and make changes rather than having to enter all of the information from scratch. I recommend using the person’s date of birth because it doesn’t change. I will skip this step because I’m working with a dummy profile, but it is pretty self explanatory.

If you choose to save your drug information, be sure to write down the number that medicare.gov gives you, as well as the date that you chose.

Next you can choose a pharmacy based on zip code. This doesn’t matter overmuch if you’re going to use a chain or independent pharmacy. If you’re working with a specialty pharmacy (for example, your doctor’s office has its own dispensary, or you’re a college student and use the university health office), then you may want to specify the pharmacy that you’ll be going to. Again, I’m going to skip this step since it doesn’t matter for most people.

At this point, all of the plans that cover the drugs you entered will show up. I like to display 10 on a page, but that would be a huge screenshot, so I’ll stick with 5 for demo purposes.

You can compare up to 3 plans to see an in-depth breakdown of the plan information (monthly premium, what the copays will be on various drugs and so on. Tick the checkbox for the plans you’re interested in and hit “Compare”. (On every page thus far, there has been a “Printer Friendly” link in the upper left corner. This is particularly helpful if you want to print out the plan summaries and detailed breakdowns for offline viewing and annotating. I use it regularly.)

Plans I don’t recommend

There’s one company that I would avoid right now and that is WellCare. They are the cheapest (as you can see from my screenshots), but they have been in some substantial hot water lately, thanks to some VERY shady accounting practices. Their stock recently plummetted from $130 to $27 at its lowest thanks to being raided by the FBI. They also regularly screw over their customers. Please, stay away from the them.

Enrolling

Enrolling in a plan can be done online or on the phone. Some companies, like Humana, like to send a rep to your house to sign you up. Some people love this, and some people hate it. I find it a little weird, personally. I’d rather call a phone number and do the whole process from beginning to end without having someone come into my home.

Technorati Tags: Medicare Part D, How-To, prescription drugs

Posted in: culture , medicare , money

MTM and the community pharmacist (OnThePharm (Hanser)) by RJS

I’ve seen a lot of hesitation on the part of community pharmacists over the last couple of years to interface with doctors, and to suggest therapy changes. When asked why, many of them have responded that they feel that it’s not their place to do so.

I think this is bollocks. I think they’re afraid.

It IS in your purview to make therapy recommendations. This is especially true for elderly people on Medicare Part D. For the first time (ever?) we have a system that indirectly rewards a large segment of the patient population for using fewer healthcare resources. (You don’t hit the donut hole, so you save money.)

But what about those people who legitimately consume large amounts of healthcare dollars? They need an advocate. And that’s YOU. The community pharmacist. When situations like this arise, you’re the one that should go to bat for the person on the other side of the counter, because no one else can.

Interfacing with a doctor

Some pharmacists are hesitant to interface with a doctor’s office. Maybe they’re worried that they’ll get stuck on the phone all day trying to make a change to a less expensive drug. But there are ways around this.

It’s called asynchronous communication. And it’s more efficient and less demanding on both your time and the doctor’s time because it allows the both of you to communicate when you each have time rather than employing The Interrupter — AKA the telephone. This is the difference between urgency and importance. What you have to say is not usually urgent in this context. But it is important.

Last November and December, I made 25-30 suggestions for drug therapy change during the course of my Medicare consulting — all of them via fax — and all of them were accepted. This saved my patients an average of $500/year. This is serious money for someone on a fixed income.

Speak their language

Not all of these changes are silly little things like switching from one drug in a class to another. Or trying an ACEi instead of an ARB. Some of these changes were broad, tackling a given medical problem (or even multiple co-morbidities) from a different angle. Many of your elderly patients — particularly those with chronic illness — see multiple doctors, and lots of times there’s no communication going on. In these instances you are the FOCAL POINT for their drug therapy. You are the gatekeeper, you see everything they take on your little computer screen. (Unless they’re one of the relatively few people who enjoy playing Musical Pharmacies.)

In these cases you’ve got to speak their language. Don’t even bother making a suggestion unless you are familiar with the latest treatment paradigms. If you want to change someone’s insulin from a hojillion-dollar version to something more reasonable, be sure you’re aware of the pharmacokinetic differences between the two. In your note to their endocrinologist, mention that you ARE aware of these differences but that you’ve spoken to Mrs. X and she is willing to try something new, and that this something new will save her $2000/year if it works.

Doctors listen, and they’re usually willing to experiment if the patient is.

There are two types of “best drug”

You bring knowledge to the table that doctors don’t have: how much things really cost. Most doctors have access to formularies if they want them, and they can relatively easily found out what kind of copay a patient will have if they prescribe X.

That used to be enough, but not anymore.

For Medicare Part D patients, the backend cost that the doctor does not have access to is a significant factor. Something might be a $28 copay, but UHC might be kicking in $250 behind the scenes that will quickly eat through someone’s drug benefit.

There are two types of “best drug”: the drug that is best from a therapeutic standpoint, and the drug that is best from a hybrid therapeutic-financial standpoint. This is the most pertinent concept of “best drug” for the person reaching for their wallet. Why reach for the Norvasc when you haven’t tried felodipine?

Make it easy for yourself

You’re a pharmacist. You’re busy. You’re machine-gunning prescriptions as fast as you can. The phone’s ringing and one of your techs called out. Today is not the day to be making therapy suggestions. (If you find yourself in this situation often, you need to attend the RJS School of Pharmacy Management.)

But even bad pharmacies have good days. Make a template with your pharmacy name, fax and telephone numbers, with a section for the patient’s information, and your notes. Personalize it with your name and titles. If you’ve got a system where you can type a note to the doctor, great. If not, don’t insult insult them with bad handwriting, even though they may not return the favor. Be the bigger person and have someone else write it if you have to — bad handwriting does nobody any favors.

Take out as much of the repetition as you can. You have better things to spend your time on than redundancy.

Battles

There’s this misconception that many pharmacists have that they’re going to have to have a battle with the doctor to make XYZ changes. First of all, this rarely happens. Second of all, if YOU are battling THE DOCTOR, there is a problem, and it’s not with you, if you are speaking on behalf of the patient as their advocate. No battles should occur; it should be a discussion. You know something the doctor doesn’t, and maybe he knows something you don’t about why s/he chose X drug instead of Y drug.

If you do end up having a battle, stick to your guns, but only if you know for a certainty that the patient will benefit if you do. Compliance issues due to money, dosing, etc. These are legitimate. Having a pet drug that you prefer is not. Conflict is not necessarily bad. Good relationships and mutual respect have been known to grow out of past conflicts.

Closing thoughts

These are the basics in effecting change as a community pharmacist. It is possible to take many of these ideas further, if you choose. Stepping on toes is never wise: step in when you see a patient is having difficulty with money, or if you can see they’re otherwise unhappy. Many patients will come right out and ask if there’s something else they can use. Some are unhappy with their doctor for any number of reasons, even though they’ve been seeing him for years. You may have an opportunity to save this patient-doctor relationship, and we all know how important good relationships are when it comes to healthcare, and how long they can take to build from scratch. They’re not something to be thrown away lightly.

Technorati Tags: Medicine, pharmacy, MTM, community pharmacy, pharmacy practice

Posted in: medical practice , medicare , money

2007 Medicare Part D Wars: Humana vs Cigna vs UnitedHealth/AARP (OnThePharm (Hanser)) by RJS

I’m predicting big things for Humana and Cigna the next time quarterly reports come out. Last year’s big Medicare Part D winner was UnitedHealth thanks to their capitalization on the phenomenon of choice paralysis. Naturally, many of the seniors that I consulted with this year discovered that AARP might not have been the best plan for their needs — but boy was it the easiest to pick!

I’m predicting lots of new medicare business for both Cigna and Humana, and a (small) percentage drop in the number of seniors who have UHC/AARP plans — though the absolute number might go up. Lots of seniors wanted to stick with their AARP plans thanks to the simplicity, but when crunching the numbers, they discovered that AARP often wasn’t even in the top 10 of the least expensive plans for the meds they were taking.

It’s hard to justify simplicity when a 10 minute phonecall could save you $500/year.

Technorati Tags: Medicine, pharmacy, AARP, UnitedHealth, Cigna, Medicare, Medicare Part D, Humana

Posted in: culture , medicare , money

Mindsets: Part D as a conservable resource rather than an expendable asset (OnThePharm (Hanser)) by RJS

I think it was Business Week that had an article about rising healthcare costs, and how to (possibly) curb the problem. I think it was the Outside Shot section (towards the end), and it focused on rewarding seniors mostly for saving the system money. Right now, there’s no incentive for anyone to turn down treatment unless they’re paying for it. This, of course, leads to gross overspending.

It occurred to me as I was sitting down, browsing the news, out-of-the-blue, that the doughnut hole is already doing this. Unless one has more than one major medical problem, it’s fairly trivial to stay under the limit. More than two major medical problems, and you’re spending so much, the doughnut is almost irrelevant. It’s a drop in the bucket.

That leaves those with two major medical problems up a creek without a paddle. They fall right smack into the doughnut hole without much recourse.

In any event, I’m not talking about these people as the focus of the article at the moment, I just wanted to point out that by having a doughnut hole, we do “reward” seniors by saving them money when they keep their drug costs below a certain point. This “tiered” approach is working quite well in its second year in effect. Last year, seniors didn’t heed warnings to not fill prescriptions they didn’t need right off, and quite a few hit the doughnut hole quite early. (In truth, it was astonishing to see how many “forgot” about the doughnut hole, or asked what happened when their prescription costs suddenly spiked.)

Once the doughnut hole came, seniors became a lot more careful. It was as though their Part D coverage became a resource to conserve rather than one that should be spent. It would be nice if all of our healthcare dollars were treated in this way.

But then there’s always the problem of decreased compliance… people like money more than they like being 100% healthy. (Most of them, anyway.)

Technorati Tags: Medicare, Medicare Part D

Posted in: culture , medical practice , medicare , money