[NPInfo] Medicare and changes

Thu Mar 6 17:29:09 PST 2008

I have heard that one out of three questions are answered incorrectly  
when people call the Medicare information line. So--probably better  
to not call them. Or, call 2 or 3 times and compare the answers, the  
way you do with help desks for software and IT issues.

I agree that health insurance coverage is too complex for the average  
person to understand. There are many educated people who think  
everyone "takes" their insurance because they lack a basic  
understanding of the whole subject. So it's even worse with older  
people who didn't think they needed to be computer literate (like my  
mother) or with indigent people who have had less opportunity. It was  
a political solution to the problem of high medication costs and not  
the best. The best would have been allowing Medicare to negotiate  
lower prices the way the VA does. However, the big pharma companies  
have powerful lobbies in Washington and made sure that didn't happen,  
since the best solution for the individual American would have cut  
into their already-huge profit margins. (Think about that the next  
time some drug rep is wining and dining you so you get a  
"educational" sales talk on their latest overpriced me-too drug. The  
money to pay for those dinners is coming out of the pockets of  
Medicare beneficiaries.)

Having said that--I think some of the large pharmacy chains-- 
Walgreen's, CVS--offer help choosing from among Part D plans in your  
area. There is some help out there. I think these companies' websites  
have explanations. Some of them offer personalized help at their  
pharmacies.

My parents are very happy with their Part D plan and feel it greatly  
reduced the cost of my Mom's medication (one medication alone,  
Arimidex, cost them $500 a month before Part D).

Stephanie

On Mar 5, 2008, at 8:26 PM, Thiem wrote:

> 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
>>
>>
>>
>> **************It's Tax Time! Get tips, forms, and advice on AOL
>> Money &
>> Finance. (http://money.aol.com/tax?NCID=aolprf00030000000001)
>> _______________________________________________
>> NPInfo mailing list
>> NPInfo at nurse.net
>> http://lists.nurse.net/mailman/listinfo/npinfo
>> *****************************
>>
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************
>
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************