[NPInfo] Medicare and changes | Part D

Thu Mar 6 06:31:50 PST 2008

I have to agree with Laura.  

First of all, my I see a lot of Medicare patients. Having written about
these plans, I knew it was confusing.  Then this past year, I helped my
Mother through this whole confusing maze since she left Kaiser.  It's a
total mess.  You cannot compare anything - it's like comparing apples to
spinach...the language, copays, deductibles, charts, etc...are all
different. Even the pharmacists find it a mess. One told me that the
medications can change literally on a weekly basis - and that includes the
generics. 

Part D is horrid in so many ways. I have one patient who really shops
around. He found he could get some of his medications for less by paying
cash, than using his Part D Plan. Several of my patients stopped taking
their medication this past fall and winter when they hit the gap...they
could no longer afford some of the medications.

I really have to question who these plans were put in place for... 

Barbara C. Phillips, NP
www.NPBusiness.ORG 
www.NPInterviews.com 

 -----Original Message-----
From: Thiem [mailto:ljthiem at yahoo.com] 
Sent: Wednesday, March 05, 2008 5:26 PM
To: NP Info
Subject: Re: [NPInfo] Medicare and changes

Stephanie, I wish it was so easy as to tell them to get online and compare
plans.  Personally, I do this for my mother.  The plans changed
significantly in the past three years when enrollment came along.  The
covered/preferred formularies changed, the coverage/copays changed.  It was
a nightmare for me-a computer savvy healthcare professional.  

Many of my patients do not have computers.  They can call Medicare.  I had
my mother try this.  Once.  First she had to get through the phone menu.
Then the person she reached, who typed in her information, got the
medication names or dosages incorrect.  The plan selections that were mailed
to her as her best choices were not.  She would have paid more for less.

Medicare D is a technological nightmare.  I can't imagine anyone finding
enrollment or plan selection easy.

Laura, NP, CNS

stephanie2u at optonline.net wrote: 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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