By Jill Flaherty
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (H.R. 1) signed into law on Dec. 8, 2003, will initiate fundamental and monumental changes in the way healthcare is administered for the seniors of our country and will affect pharmacists significantly. Forty-one million Medicare beneficiaries will soon have access to prescription drug coverage. These seniors will have the choice of enrolling in the Medicare drug benefit, named Medicare Part D.

The 850-page Medicare law is still in need of significant improvements in order to sustain a meaningful drug benefit program. New regulations and proposed amendments are currently being introduced in Congress to address the many concerns with the language in the passed law. Until changes are made to the law, we are left to examine where the weaknesses in the language of the law lie.

A few of the key pharmacy components in the Medicare law that warrant discussion include the cost of the comprehensive drug benefit, the temporary discount cards, a patient’s choice of pharmacy, transparency in program oversight and Medication Therapy Management Services (MTMS).

Cost of the drug benefit: The 2005 fiscal year budget increased the proposed cost of the Medicare reform by an additional $140 billion over 10 years. Critics are concerned that this is a result of a provision in the law that prevents the government from negotiating with manufacturers for discounted prices on medications, which many see as the greatest weakness in the drug benefit.

Temporary discount cards: The optional and temporary drug discount cards began enrolling members May 3, 2004, and began utilizing the discounts June 4. The savings will not be as significant as many seniors are expecting; current estimates are 10-15 percent, savings that fall short of the drug coverage beneficiaries need. Other concerns exist with the discount cards: Plan sponsors are allowed to limit a patient’s choice of pharmacy by varying the price among providers, and sponsors are not required to reimburse pharmacies a portion of negotiated discounts.

Patient’s choice of pharmacy: A “level playing field” for community pharmacies is needed to provide patients pharmacy choices. Many pharmacists are concerned that patients will be forced into a certain type of pharmacy (notably mail order) as a result of price incentives. Although community pharmacies will be able to provide the same services as mail order pharmacy (such as a 90-day supply of medications), patients will pay the cost differential in providing services.
Transparency in benefit oversight: The Medicare benefit will be led by Pharmacy Benefit Managers. Many in pharmacy are concerned that insufficient oversight will result in a drug benefit that does not fairly utilize and compensate the 55,000 pharmacies in the country. The oversight will require more uniformity and transparency than exists in the current Medicare law.

Medication therapy management services: The drug benefit is not all doom and gloom. There is at least one inclusion in the law that will prove to be a significant benefit to both seniors and pharmacy. MTMS must be included for seniors, and may be provided by a pharmacist. Pharmacists are specifically identified as providers under the new Medicare Part D, and plan sponsors must consider the time and resources used by pharmacists to provide MTMS when establishing fees for pharmacies. This is significant since pharmacists, as the medication experts, are in the best position to provide these services to seniors.

Clearly, many questions remain. It will take Congress more time to address these issues as well as many others not yet uncovered. A common saying on Capital Hill appropriately fits the Medicare law: “Never let perfect be the enemy of good.” The Medicare law is certainly not perfect, but it is a starting point that may prove to be a good thing for seniors and pharmacy.

Rather than complain about the flawed language of the bill, consider taking action to assist in improving the outcomes of the Medicare law. What can pharmacists do to improve the Medicare benefit?
• Thank your members of Congress for including MTMS in the Medicare law.
• Continually communicate with your members of Congress to address the issues that will affect your practice of pharmacy.
• Encourage and assist your senior patients in enrolling in a temporary drug discount card that best fits their needs.
• Continue the valuable services you provide on a daily basis. Pharmacists will be the professionals who make the drug benefit work!

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