My life with dialysis and kidney disease
medicare
Medicare Part D – How is it Affecting Small Pharmacies?
Feb 10th
I promised yesterday that I would write a little something today about the new Medicare prescription drug coverage, and how it is affecting smaller independent pharmacies.
I’ve suddenly become very drowsy while at dialysis, and I’m a little “out of it”, so my apologies if this is short, useless, or otherwise inarticulate.
Basically, this new plan stands to severely and negatively affect small independently owned pharmacies. Don’t get me wrong, it will hurt all pharmacies equally, but large stores with other retail departments will be able to mitigate these losses much easier. It’s worth it to Walgreens to make very little profit on a prescription fill, if that person happens to take stroll down the “seasonal” isle while they’re waiting, and purchase an obnoxious dancing Santa Clause. That Santa was probably built in China, and delivers a huge gross profit margin.
Basically, Medicare has decided to start helping people with their prescription drugs. Someone has to pay for it though, and it appears that in many cases, it is the pharmacist who is footing the bill.
Sure, as a patient I will pay a monthly premium, and still still pay a small copay for the drugs that are filled – but I’m doing that with the assumption that Medicare is then paying the pharmacist the difference. This doesn’t appear to be the case.
Speaking with one local pharmacist, it was clear that his business wouldn’t last long if the majority of his patients were on Medicare Part D.
Let’s say “Patient X” comes in to fill his prescription, which has a wholesale cost (cost to the pharmacist) of $250. Now, “X” pays let’s say $5 (or perhaps $0) because this drug is a “Tier 1″ drug on his plan. “X” whistles a cheery tune as he walks out the door with his drugs. The pharmacist though, will only be reimbursed $258 from Medicare. $13 on a $250 purchase? Can he really stay in business with such a low gross profit margin? Certainly not …
It gets worse – with so many different plans and providers, the billing part of it seems to be a nightmare. One pharmacist I spoke with said that he already had $30,000 out in inventory, without any reimbursement yet. How can he keep the doors open with no inventory, and no money to order more? How long does he have to wait to be reimbursed?
As I’ve said many times before, I don’t have all of the answers.
I don’t know how to fix this, but it seems that Part D might not be all it’s cracked up to be, for both the patients and the pharmacists.
Certainly it is a welcome help to some of us, but at what cost? I’d almost rather continue paying out of pocket for all my drugs, and at least know that I’m helping to keep a local business in operation. The reality though, is that I simply can’t afford to. I just hope that the small independent pharmacies will be able to keep their doors open – or at least adapt to the market and remain viable.
Perhaps they can all put in seasonal isles, photo departments, and $5 DVD bins.
Medicare Part D – Selecting the Right Plan
Feb 9th
I’ve been looking at these plans for months. I keep wondering to myself, how many other twenty-somethings are sitting at home right now looking at medicare prescription coverage plans?
Here’s the deal for those of you not familiar:
Medicare is now going to start “helping” us with prescription drug coverage. The “approved” plans will be offered by private companies, and can vary quite a bit in coverage, and what medications they allow. The rules are fairly simple, an approved plan will cover your drugs at x% until you reach an out-of-pocket total of $2500. Here’s where it gets tricky though. The plans then cover nothing between $2500 and $3600, at which point the plan picks back up, and covers the drugs at a different rate.
That’s right, those of you with high prescription drug costs are still going to pay a lot out of pocket (what a surprise).
So let’s say you’re taking some fairly useless cholesterol medication (you know, the kind that lowers your numbers but doesn’t improve your health). Let’s say you pick up that prescription for $50.00 a month. With your shiny new Medicare Part D plan, you will pay a monthly premium between roughly $25 and $50 (depending on the provider). Assuming your drug is “Tier 1″ drug, you might have a copay of $0, or $5, or whatever the plan decides. Well that’s a pretty good deal if you have a low monthly premium, you might save $20 or $30 a month. It’s even better if you are on several medications, and find a plan that includes all of them, and considers them all “Tier 1″.
But what happens when you have a lot of expensive medication, and can’t find a plan that considers them all “Tier 1?” What happens if you absolutely need a medication, and it is Tier 4?
I received the documentation for the plan from my Medicare Supplemental Provider (Anthem) several weeks ago. Unfortunately, after looking through their formulary only 3 of my 5 medications were listed, and only two of those were Tier 1 ($5 a fill). So the plan costs ~$38 a month, and will give me my two cheapest medications for $5 a fill. Really though, I’m only saving about $25 on those two fills, which hardly makes up for the monthly premium – not to mention I still have the two more expensive medications which are going to add up to about ~$190/month.
Well that doesn’t sound very awesome.
So why are the fatcats in Washington patting themselves on the back for getting this passed?
To further confuse things, there are literally hundreds of plans available, all with different formularies (what they will cover and at what %), different preferred pharmacies, and different territories. If you have the patience to sift through it all, you might find a decent plan somewhere else in the U.S., that happens to be offered in your State and County, that covers all or most of your meds, and considers them all Tier 1.
I think I finally found this plan last night.
No I didn’t have the patience to go through all of it, but thankfully the Medicare web site has a pretty useful utility to help you find the best plan (awwww, finally the meat of this loquacious rant).
Just head on over to the Medicare site, and you will find a link right on the first page where you can go to begin comparing plans. It will ask for some of your medicare information, so have your card handy.
Next it will ask you what medications you’re currently on, and what dosages. After you put in all of this information it will show you a list of plans offered in your area that cover all, or some of your listed meds. It will then sort them by price, and will give you estimated annual and monthly costs, as well as cost analysis of preferred pharmacy vs. mail order pharmacy.
The plan I found has no annual deductible, and a low monthly premium (under $30 if I remember correctly). It covers four of my five drugs at the Tier 1 level (which means I have a $0 copay), and the fifth at a Tier 4, which is only slightly discounted. Still though, I will get away monthly at around $100 instead of ~$250.
“Wow, that sounds great Jonathan!”
Yeah … for now perhaps. But these providers can drop their with little notice. Hopefully though this will cut down on drug costs for me for awhile. The “killer” right now is phoslo, which paying out-of-pocket costs me $130/month. When my phosphorous is high that cost goes up as I take more of it.
“Why don’t you take Renagel?”
Because Renagel would cost me ~$600/month. They used to have a program to help people like me without prescription coverage, but recently have put a stop to it, most likely because of the new Medicare Part D plans that will cover the drug. I did find some plans that had Renagel as a Tier 1 drug, and I contemplated switching to Renagel to get one of these plans – but after enough searching I finally found one that covered almost everything I was on, which in the end is cheaper, and therefore beneficial.
If I can scrape enough together to purchase three months at a time I will save even more, and will hopefully never again have the problem I have this month: picking and choosing which drugs I can go without or take less of due to financial constraints.
Tomorrow: Part Two
How Medicare Part D coverage affects locally owned independent pharmacies.
