Medicare Part D—Again!

This is, I guess, an update/follow-up on Lin’s blog of November 28, “No Surprises Here.”

Today’s New York Times has an op ed. piece ("Attention Medicare Shoppers . . .") by a family doctor advising us to shop carefully for a Medicare Prescription Drug plan. “By asking the right questions and comparing plans, the savvy consumer can save more with Medicare than at Macy's,” suggests Lisa Doggett. She goes on to describe how, since she is routinely cost conscious when prescribing drugs to patients, and looks for substitutions and generics when possible, she applies this strategy to searching for a Medicare Part D plan for her grandmother. At first Doggett is “dismayed.” “The "best" plan cost $3,242 annually, even more than her current drug bill [about $3000] without any insurance.” But by being a smart shopper, she is able to reduce her grandmother’s cost for a plan significantly.

I studied her medication list and discovered that with a few medically insignificant changes, she would reduce her total drug costs substantially. The key is understanding that most medications are considered part of a "class" based on how they work, and each class usually includes two or more medicines of similar effectiveness. . . .

Reviewing my grandmother's medication list, I removed just one medicine, Prilosec, a heartburn drug. My grandmother was getting it by prescription, but since 2003 it has been available over the counter for less than $25 a month. By switching to the cheaper version, my grandmother lowered her projected costs, according to the Medicare Web site, to $1,945 annually, a net savings of more than $1,000.

Further switches among prescription cholesterol and blood pressure medications lowered her costs further, to only $960 annually if she chooses to receive the medicines by mail (or to $1,267 if she prefers the local pharmacy). I found these savings by reviewing the formularies on the Web sites of several different plans and switching her to medicines that were "preferred" under the drug benefit. Once her doctor agreed to the proposed changes, we signed her up.

Is this a model for the rest of us? Now really!!

Yes, most of us who are in the health professions could probably do what Lisa Doggett did, but first, as my mother always told me, time is money. I was already appalled at how long it took to compare plans on the Medicare site: you can only do three at a time. What is that all about? And some plans have no donut hole, so you really have to look carefully to do the comparison because premiums are deceptive. And then, if you are not an MD with some prior knowledge of these drugs, the research it would take to take the next steps Doggett advises is daunting: check to see if there are OTC equivalents, find the formularies, make reasonable judgments about substitutions, contact the various doctors and get approval for these changes. No, it is frankly an outrage that this kind of research is required in order to make the best decision about a Medicare “benefit” plan. Certainly this is a new kind of elitism: the small group of older people who have younger relatives who are doctors willing to spend this kind of time (primary care probably) form the elite group who will be able to make the smartest shopping decisions.

Now for the kicker. Remember how the AARP’s support put the votes over the line and enabled this outrageous prescription drug bill to be passed? I am now hearing repeatedly that people are choosing the AARP benefit. In fact, it seems to come up first in the list of benefits to compare. Funny thing about that. I called a pharmacist recently to see which plans the pharmacy was on (since the name did not come up in the list—another glitch in the Medicare.gov plan finder program) and the pharmacist, without prompting, advised me that most of his customers were choosing the AARP plan.

We can use the AARP actions as a case study in advocacy conflict of interest for our graduate students. But frankly, the whole picture makes me frustrated and furious. And, to be truthful, I have not yet found the best plan for my in-laws.