[NPInfo] Medicare and changes

[stephanie2u at optonline.net]

Hi Dee,

I just read your post from some days ago.

I sympathize with your frustration. My understanding about Medicare Part D is that it is not Medicare that is "changing all the patients' medications." Medicare is paying for the medications in part, however the drug plans are all put together by private companies and Medicare enrollees choose a Part D plan. Each plan offers certain medications at a certain discount. 

The patient is really the one who is responsible for knowing what drugs are covered by the plan he or she chooses. Every year they have a short period of time in which to change to a different plan. I believe it's in November. The companies offering the Part D plans do sometimes change the drugs offered from year to year, so even if the patient doesn't change plans, the coverage may change. There are websites which compare Part D plans and help patients choose the plan which is the best bargain for them, considering the medications they need. The patients need to be somewhat pro-active and shop around.

I have not dealt with this, but there's more than one way to skin a cat, and many medications in the same class are equally efficacious. When it comes time for re-enrollment, perhaps you could give your patients a list of their medications and acceptable alternatives you could prescribe for each medication: e.g., lovastatin, atorvastatin or simvastatin instead of Crestor. That way they could shop for a plan that includes as many as possible of the alternatives available, and minimize their medication expenses.  

You can get more information about Part D online. Here is one site. It mentions an option for people with low income:
http://www.medicare.gov/medicarereform/drugbenefit.asp

You can find out what all you are permitted to do by law in your state if you look through the law under which nurse practitioners are licensed. That way, you will not find yourself in the position of prescribing or ordering something which is not in your legal scope of practice. In our state, NPs are regulated by the Nurse Practice Act. I don't know how it is in South Carolina. 

All this stuff is more legal and business related than clinical, but health care includes all those aspects. It can take awhile to learn all the ins and outs. Don't get discouraged!

Stephanie Walker, FNP

----- Original Message -----
From: MIRONNYE at aol.com
Date: Monday, March 3, 2008 11:40 pm
Subject: [NPInfo] Medicare and changes
To: npinfo at nurse.net

> Hi
> My name is Dee and I am FNP in South Carolina. Has anyone had 
> the 
> frustration I have had with Medicare changing all the patients' 
> medicines? I work 
> with indigent patients and they cannot afford some of the 
> medicines when 
> Medicare changes their drug programs. They are being changed 
> every year and I spend 
> most of the first new year visits changing their medications so 
> they can 
> afford them. At first, I was happy with this Medicare part D, 
> but after I 
> started getting calls from pharmacies about changing the 
> medicines because they 
> weren't covered on part D, I began to get weary. Sometimes I 
> have to change to 
> medicines that don't help as well and I feel it is the patient 
> that suffers. 
> A lot of my patients don't take all of their medicines because 
> they can't 
> afford them. I had one patient tell me one of her medicines 
> was $65 and she 
> probably will not be getting it. She absolutely refused to use 
> Crestor as it 
> would cost her $111 a month. And her cholesterol is well 
> controlled! She has 
> already had stents placed twice; so I was not too crazy about 
> changing her 
> medicine. Lipitor was even listed as a tier 3 which would have 
> been $65 or 
> more.
> 
> Also, I just realized I could not order home health for my 
> patients. I work 
> in a nurse practitioner run clinic. I do have MD who can sign 
> for this, but 
> she never sees these patients-I do. Now I'm getting forms 
> saying I can't 
> sign for diabetic shoes or equipment. Am I just being overly 
> sensitive? 
> Anyone else feeling this frustration??
> 
> Thanks for letting me vent.
> 
> D. Devlin, FNP
> Columbia, SC
> 
> 
> 
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