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News from WOSU 820 AM
Medicare Plan D
(Part 1 of 3)
Erika Ragaji:We’ve been contacting physicians quite a bit more frequently since the start of Medicare Part D.
Reporter Christina Morgan: Erika Ragaji and her husband Nik own Westside Pharmacy in the 1200 block of West Broad Street. The majority of the Ragajis’ customers are on Medicaid, a state and federal assistance program. Generally, people over the age of 65 who are on Medicaid have an income of less than $6,000 per year. Before January 1 of this year, the Medicaid program paid for prescription drugs, and those covered did not have to worry about co-payments. As of December 31, though, Medicaid stopped covering drug costs for individuals on both Medicaid and Medicare, and Plan D kicked in. Now, those receiving Medicare and Medicaid pay as much as $5 per prescription; they pay less for generic drugs. Even though the new co-pays might total only $25 per month for a typical customer at Westside Pharmacy, Ragaji says, it’s $25 that customer was not prepared to spend.
Ragaji: If they don’t have that money budgeted into their account, they’re going to say ‘Well, I don’t need that medication this month. I can’t afford that one this month.’ They’re only taking part of the medication they need and they’re putting their health at risk.
Morgan: Different insurance plans offered as part of Medicare’s plan D cover different drugs. The list of medications each plan covers is called a “formulary.” Ragaji says pharmacists are checking prescriptions with doctors when customer’s prescriptions are not part of their plan’s formulary. People who receive both Medicaid and Medicare are being automatically enrolled in Plan D and randomly placed in one of about 10 plans. That’s if they did not choose a coverage option first.
Ragaji: Some of them didn’t understand this. Many of them said they had never gotten any information on it, and in some cases that was true. The government did fail some of these people by not enrolling them and not informing them properly.
Morgan:Pickerington Pharmacist Eric Hals serves middle- to upper-income customers at the Kroger Pharmacy on Hill Road. Those receiving Medicare can choose from more than three-dozen insurance options for prescription drug coverage. The first thing to consider, of course, Hals says, is whether a plan covers the drugs you take. But even if you do pick a plan that covers all your medications, there is a potential snag.
Eric Hals: The problem is like any other insurance companies, not just with Medicare Plan D, that formularies for these insurance companies can change—monthly—and you can only change I think like once a year, but that’s kind of the way the insurance world works.
Morgan:If an insurance plan is changing its formulary, it is required to give people affected by the change 60 days’ notice and continue covering their drugs for 60 days. For those on Medicare and Medicaid, insurance companies can still change the formularies every month, but consumers are free to change plans at any time. All they have to do is figure out which insurance plan will cover all of the medications they need for at least 60 days.
Morgan: Both Ragaji and Hals predict that the Medicare prescription drug plan will prompt a change in the way doctors write prescriptions.
Ragaji: They’ll think about, ‘Is there something older, that’s available generically that we can use for this patient that will work for them?’
Morgan:And for all the strain caused by the introduction of Medicare’s Plan D, there is some irony
Hals: Certain classes of drugs aren’t covered, like anti-anxiety agents.
Morgan: Registered pharmacist Eric Hals chairs the public relations committee for the Academy of Pharmacy of Central Ohio. Registered pharmacist Erika Ragaji is co-owner of Westside Pharmacy. Both believe things will get better for pharmacists and for their customers as everyone becomes more familiar with the various insurance options offered under Medicare Plan D and which plan best meets the needs of an individual customer.