ASSOCIATION PHARMACIST CRITIQUES MEDICARE PROGRAM 2004-08-16 (2)

Dan Alaimo

WASHINGTON -- This spring, the Medicare discount drug card program got under way. The discount cards are the initial phase of a permanent Medicare prescription benefit that will take effect in January 2006. Discussions are now starting on the regulations that will guide that program. To get a perspective of how the card program has gone so far and what can be expected of the permanent benefit, SN interviewed Dr. John A. Gans, executive vice president and chief executive officer of the American Pharmacists Association here. Gans has a broad spectrum of experience in pharmacy. He started his career as a community pharmacist, has worked in a hospital, conducted research, and served as the dean of the School of Pharmacy of the Philadelphia College of Pharmacy and Science, where he had earned his doctorate in pharmacy. He also is involved in international pharmacy organizations.

SN: What is your take on the controversy surrounding the Medicare discount card program?

GANS: I'm not sure "controversy" is the right term. "Confusion" is certainly accurate, and that was to be expected. There are certainly some hitches in the system, but it is unfortunate that some Medicare patients who are eligible for the $600 credit won't get to use that credit because they don't know about it -- or don't know how to navigate the system. We have to find a way to identify problems and improve systems without scaring patients away from a good benefit. APhA has never been a fan of discount cards, but at least the Medicare program is better than most -- it should only be around for a short period of time, and includes that $600 for qualifying patients.

SN: What kind of start did it have, how do you see it being accepted now, and what do you see for the rest of the year?

GANS: I thought the start of the program would be more difficult than it was. Pharmacists and seniors are still finding problems, and we're working with the Centers for Medicare and Medicaid Services to work those out. I expect the rest of the year to be similar to our current experience -- some seniors asking questions and some seniors just missing out on a good, but not great, opportunity.

SN: What makes the difference between retailers who have had a good experience with the card program and those who haven't?

GANS: Preparation, preparation, preparation. No one likes change, but preparation can certainly help. When pharmacy staff has a good baseline of knowledge, it helps focus their conversation and gives them a comfort level.

SN: What kind of counseling can pharmacists be reasonably expected to provide customers about the card program?

GANS: Pharmacists and other pharmacy staff are helping seniors analyze various card options today. If they provide in-depth analysis and benefit counseling, it would make sense to charge beneficiaries a reasonable fee for that service. After the Office of the Inspector General cautioned against any payment from the card sponsors for this counseling, APhA went straight to CMS and asked them to pay for these services. It makes sense that CMS would pay for the service that seniors want -- direct contact with a knowledgeable person. Unfortunately, CMS didn't see it that way and turned down our request. But we'll keep asking. It just makes sense, and helps CMS and Medicare beneficiaries.

SN: How do you see the permanent Medicare drug benefit unfolding as we get closer to 2006?

GANS: With the release of the proposed regulations last week, we're starting to get a clearer picture of what 2006 will look like. The profession can have a huge impact on the permanent benefit, but we all need to get involved. Eleven pharmacy organizations, including APhA, just completed a consensus definition for medication therapy management services, and we'll be working to assure that CMS looks at that definition in developing the final regulations.

We will also learn from the discount card. One lesson we learned is that choice [among discount card programs] is good, but nearly 40 choices is confusing. We also learned that some card sponsors have flaws in their pharmacy networks -- reporting "contracts" with pharmacies that are no longer in business. This helps inform the 2006 benefit, and should inspire more CMS involvement in oversight of the drug benefit plans.