Medicare recipients face a daunting task at the end of the year: deciding what prescription drug plan to choose.
The deadline to enroll or change plans is Dec. 31 for Medicare Part D, a prescription drug plan available to everyone with Medicare. The choices are often confusing because of the new system enacted in 2006. College of Pharmacy students at Western University of Health Sciences in Pomona, Calif., are participating in the statewide education initiative Partners in D, which helps Medicare recipients understand Medicare Part D.
Pharmacy students recently visited Palomares Park Senior Center in Pomona for one-on-one sessions with Medicare members, providing advice about the proper Part D plan to enroll in based on their medications. They also evaluated whether a person could reduce or modify the amount of medications taken.
The students helped her get into a lower payment plan, said Pomona resident Sylvia Brown.
“It was really helpful here today,” she said. “Everyone was really nice.”
One woman was paying $3,000 annually for a prescription drug plan, and they were able to find a different plan that covered the prescriptions she needed and cost $500, said Sevag Tachejian, PharmD 2011.But she resisted making a change.
“She was overpaying, but she was attached to (her plan),” he said. “It took a little convincing. They don’t want to change.”
This issue is confusing because there are about 56 prescription drug plans in California, said Micah Hata, PharmD, WesternU community pharmacy practice resident.
Some people aren’t taking a lot of medications, so they don’t think they need to sign up for a plan now. But if they’re Medicare eligible and choose to sign up later, they get a penalty tacked on to their monthly premium, Hata said.
The penalty is based on the number of months you are eligible for Medicare but do not sign up for a plan. If someone signs up for a plan one year after they’re eligible, they will have 12 percent of the average national monthly premium added to their regular premium. The penalty is 1 percent for every month you do not sign up.
Even if a Medicare-eligible person doesn’t take any prescription drugs, they might consider signing up for the cheapest plan so they won’t face that penalty down the road, Hata said.
People who are dual eligible, with Medicare and Medi-Cal, or meet certain financial conditions will not incur a penalty.
WesternU students are participating in the statewide initiative Partners in D, started by UC San Francisco and funded by a $3.7-million grant over 3½ years by The Amgen Foundation. All seven pharmacy schools in California are participating in the program.
“The goal is to educate seniors about Medicare Part D, and also just to give them options in terms of different plans that are available,” Hata said. “And ideally to help them save money based on the prescription drugs they’re taking.”
Medicare Part D has resulted in a lot more work for pharmacists to make sure the patient gets the right medication, said Timothy Cutler, PharmD, assistant clinical professor of pharmacy at UC San Francisco School of Pharmacy, co-investigator in the Partners in D grant and a member of the California Pharmacists Association. UC San Francisco School of Pharmacy faculty members Marilyn R. Stebbins, PharmD, and Helene L. Lipton, PhD, serve as co-principal investigators of the project.
Even if you understand a plan one year, the next year you have to re-educate yourself.
“All plans change every year,” Cutler said. “Nothing stays the same. Once you figure it out, it changes all over again.”
For instance, in 2007 there were nine plans approved for somebody with both Medi-Cal and Medicare, but in 2008 the four largest of those plans will no longer be available, Cutler said.
“All those enrolled are going to be reshuffled to new plans,” Cutler said. “That transition is going to be very difficult for both the patient and the pharmacist.”
Nearly 800 pharmacy students have trained with the Partners in D outreach curriculum, and these students have worked with nearly 200 Medicare beneficiaries in one-on-one sessions, Cutler said. Group presentations have reached an additional 250 Medicare patients.
“This is a really great opportunity to take something they learn in the classroom and apply it to a patient,” he said. “It’s good to give them early experience with advocacy in helping others.”
Pharmacy students can help a patient evaluate whether they can cut down the number of pills they’re taking or if they are taking medication unnecessarily, said Karl Hess, PharmD, assistant professor in WesternU’s College of Pharmacy.
Another issue is the “doughnut hole,” or gap in coverage. If you reach a certain level of drug costs during the year, you hit the hole and may have to pay all costs out of pocket. If the amount you pay continues to increase you reach the catastrophic coverage level, where you receive coverage again.
“All thresholds change on a yearly basis,” Hess said.
Fontana resident John Valdez said he is in the “doughnut hole” and is trying to educate himself on his options. After talking with WesternU pharmacy students, he realizes his pharmacist is a good person to consult.
“I learned where to cut my costs, what direction I should take with the prescriptions I’m taking, and how to bring my concerns to my pharmacist,” Valdez said. “He’ll be my intermediate. He’s an advocate for the public.”
For more information about Medicare Part D visit the Web site www.medicare.gov or call (800) MEDICARE [(800) 633-4227].
For more information about Partners in D visit the Web site www.partnersind.com.