Show #359 Airing Sunday, 10/8/06
Medicare Part D has now been part of our lives for about nine months. So how's this brainchild of Congress and the insurance industry faring? The answer is "not so good," according to a recent survey by the Kaiser Family Foundation. Let's take a look at a few of the biggest problems reported by pharmacists and doctors.
Problem #1: The program is confusing, and the government hasn't done anywhere near enough to educate people. When Part D was first passed, experts warned that this program was way too confusing. Ready for startling and dangerous statistics? [STILL #2] Eighty-six percent of pharmacists report that their patients do not understand how the Part D program works. 86%--that means almost no one understands the program very well. And that's a real prescription for trouble, because it increases the odds that you won't get the benefits you're entitled to receive.
If you're confused about the Part D benefit, just ask your doctor, right? Wrong! Almost 2/3 of all docs report that they can't figure out Part D either.
Problem #2: Needed drugs aren't covered. There are dozens of different drug plans offered under Part D, and each plan covers different drugs. This has led to real unhealthy consequences.
Two-thirds of all pharmacists say they've had customers leave without their needed medications because their prescribed drugs weren't covered under their plan. What good is the program to you if the medications you need aren't covered?
Problem #3: People can't get their medications due to Part D red tape. More than half of all pharmacists report that their patients had trouble getting needed medications thanks to three program management rules:
- The patient had not obtained prior authorization from the plan.
- The prescription exceeded the plan's pill quantity limits.
- And the patient had not first tried to use less expensive drugs.
These problems, and many more, can affect anyone at any time. But who is hurt the most? The Kaiser study showed that folks who have faced the most problems with Part D are:
- Those in the worst health.
- People taking the most medications.
- And folks with the lowest incomes.
The Medicare Part D law actually was passed three years ago. It's been up and running for more than nine months. Yet most people still don't understand it, many people's drugs are not covered, and complicated, burdensome bureaucratic red tape prevents too many folks from getting their medications when they need them. Our members of Congress need to revisit their creation and find ways to make this program work just as well as the health insurance plans they have for themselves.
