YEAR TWO OF PART D

WENDY TOTH

The New Year marks the second of the Medicare Part D prescription drug plan, and with it, supermarket pharmacies are hoping to better serve beneficiaries.

Most of the glitches in the enrollment system, such as 2006's overworked enrollee database, have been smoothed out, and both pharmacists and customers are more familiar with the plan.

“Last year the system wasn't working right, people weren't listed under their plans and Medicare couldn't enter them in fast enough,” said John Fegan, senior vice president of pharmacy for Ahold USA, Braintree, Mass.

This year more beneficiaries are signing up or switching plans, and pharmacists are better prepared to assist them.

“A large number of patients are already enrolled this year, so it is now a matter of determining if they are changing plans, but at least they are still in the system,” Fegan said.

With some of the plans altering their formularies, however, “a little more education and time at the counter will need to take place with those patients who are not up to speed,” said Dan Milovich, director of pharmacy operations, Bashas', Chandler, Ariz.

Dec. 31, 2006, was the deadline for beneficiaries to change or choose their Medicare health and drug coverage for 2007. Between Nov. 15 and Dec. 27, the Centers for Medicare and Medicaid Services, Baltimore, reported that it had processed more than 280,000 enrollments.

Also, indicating that thousands of beneficiaries were reviewing their current coverage to decide if they should elect for a change, there were 61 million page views on www.medicare.gov and 30 million page views on the website's Plan Finder between Oct. 15 and Dec. 27, CMS reported.

To promote awareness of enrollment and the ability to change plans among the beneficiary population, CMS ran an outreach campaign starting in November that included programs started in conjunction with many retail pharmacies.

Among them, pharmacists of Kroger Co., Cincinnati, were trained by CMS to assist customers in considering plan options. Wal-Mart Stores, Bentonville, Ark., provided over 4,000 community outreach events, and CVS/pharmacy, Woonsocket, R.I., hosted Medicare Tuesdays — in-store informational sessions held during the enrollment period, which began Nov. 15.

Ahold hired a number of new pharmacists this year, so enrollment instructions were sent out to every pharmacist, Fegan said. “Even for our experienced pharmacists, it served as a refresher.”

Although Ahold is not anticipating any major problems this year, billing problems for the month or two after the sign-up period are expected, Fegan said.

MONEY MATTERS

The billing issue lies with Wellpoint, Indianapolis, a plan benefit manager that serves as a “facilitator” for beneficiaries who sign up without choosing a specific plan. “Those who don't choose a plan are automatically pushed into Wellpoint, and Wellpoint then decides which plan they will end up with,” Fegan said.

While this is a great way to take care of patients, the responsibility of billing the right company is put on the pharmacy, he said. For example, at retail the pharmacy may find the patient's eligibility record under Wellpoint. However, the patient might have been put into a new plan, with the retailer not yet having received that information from CMS. The retailer would then mistakenly bill Wellpoint for the prescription.

“Wellpoint will come back to us and tell us the patient is not with their plan and we need to bill the appropriate plan,” Fegan said.

Although billing and reimbursement may be disrupted for a month or two, the payoff comes in the form of better care for patients and more business for pharmacy. A recent study from Prime Therapeutics, a plan benefit manager in St. Paul, Minn., found that patients are much more likely to continue drug therapy if their co-pays are low.

In the study, patients paying $10 for antihypertensive drug prescriptions remained on their medication 13% longer than those paying $25.

This means beneficiaries will buy drugs more often and be able to afford other items as well.

However, a study conducted by Information Resources Inc., Chicago, in June found that with over 30 million seniors signed up for Medicare Part D in 2006, supermarkets lost 2.2 share points in prescription transactions and 1.1 share points in non-prescription health care purchases during the four-month period following enrollment.

“Aggressive outreach to seniors by supercenters made the difference,” the study said.

In addition, some seniors may be more wedded to shopping at a traditional drug outlet for their prescriptions and health care needs, said Ty Kelley, director of government relations for Food Marketing Institute, Arlington, Va. “It's a matter of trying to get them to change their behavior.”

“You can never do enough to attract customers, be it Medicare or not. We did not experience a disappointing turnout in our stores after the last enrollment period,” Milovich said.

Last year, many supermarkets weren't concentrating on the marketing aspect of the drug plan, Fegan said. “We had an influx of patients, margins being lowered and expenses increasing, and we were focused on determining the impact of the plan on our overall operation.

“This year we can focus on attracting these folks to the grocery side of the store with the idea that seniors need healthy food.”

WOOING PATIENTS

Pharmacy-based outreach and services are advantageous for supermarkets, said Curtis Maki, vice president, HBC/GM/Rx, Topco Associates, Skokie, Ill. “Medicare Part D has provided eligible consumers the ability to purchase prescription drugs that may have previously been beyond their reach. This has substantially increased the number of consumers filling prescriptions.”

Bringing those consumers into the supermarket to fill their prescriptions not only increases foot traffic, it also expands consumer spend to areas beyond prescription drugs, Maki said.

Seniors have more time to spend and “are out there doing the grocery shopping, hopefully with a little more money now that the cost of medication is down,” Fegan said.

Topco, which is a member-owned cooperative, now offers supermarkets an “Aggregated Pharmacy Initiative” to provide them with drug purchasing power that can help them compete and offer customers value-added programs for health needs, Maki said.

Much like the RxAdvantEdge card, which allows customers of Price Chopper Supermarkets, Schenectady, N.Y., to save between 10% and 85% on all brand-name and generic drugs — a plan implemented after the $4 generic prescription drug program by Wal-Mart Stores — Topco is offering to help members implement prescription discount card programs that can stand on their own or be tied to the store's value card.

Topco is also helping member stores start in-store health-related services such as disease state management programs, “which help sell the entire store environment,” Maki said.

This type of service, known under Medicare Part D legislation as Medication Therapy Management or MTM, is one that pharmacies are allowed to be reimbursed for through individual plan providers.

MTM may be provided by pharmacists to counsel patients managing multiple drugs.

Although the legislation does not require payment, or state an amount of payment, some plan benefit managers are electing to work with retail pharmacies on offering this service to patients.

“We have been working very closely with one plan benefit manager in particular and have been getting reimbursed for MTM services. In fact, we are sitting down with MTM patients every week,” Milovich said.

Ahold is also being offered the opportunity by one plan provider to counsel patients for a fee, Fegan said. “If we miss this opportunity, it could be given to other operators,” he said.

A plan provider could also administer MTM internally through phone counseling or by other means such as nurse practitioners or reminder letters.

“When retailers are renewing contracts with plan sponsors, they ought to be asking that payments reflect MTM services,” Kelley said.

Managing More Medications

Supermarket pharmacies are finding more ways to connect with patients one-on-one.

A part of the Medicare Part D prescription drug plan allows pharmacists to be reimbursed for counseling patients taking multiple medications. This is known as Medication Therapy Management. If plan sponsors choose not to make this option available, there are other ways to get involved.

“I think [the industry is] moving ahead on MTM, but not necessarily under Medicare,” said John Fegan, senior vice president of pharmacy for Ahold USA, Quincy, Mass.

The entire profession is taking therapy very seriously, and while many insurance groups are approaching retail pharmacies about MTM, other forms of it are developing, Fegan said.

One example is pharmacist-administered flu shots. “More and more states are allowing pharmacists to administer these shots, and the pharmacists are talking to patients, scheduling appointments and getting into the mode of personal interaction,” Fegan said.

This past flu season, both Save Mart Supermarkets, Modesto, Calif., and Publix Super Markets, Lakeland, Fla., licensed a program from the American Pharmacists Association, Washington, called Pharmacy Based Immunization Delivery, to train pharmacists to conduct immunization clinics at some store locations.

“More pharmacists are stepping up to the plate in terms of serving patients,” Fegan said.

For the next flu season, Save Mart plans to “use our own pharmacists as much as possible, filling in with nurse practitioners on the sites where we don't have pharmacists trained to do it,” said Michele Snider, director of pharmacy.
— W.T.