Insight Matters
Fall 2005

Medicare Part D: The Devil will be in the Details
by Mark Munetz, M.D., Past President

I was asked to write a short introduction to an update on Medicare Part D, the new prescription drug coverage. This is challenging, as there are so many questions and possible unintended consequences as this massive new federal program unfolds. Our hope is that our patients will continue to have access to the medications and other services they need, but there are still unanswered questions and probably questions we haven't even thought of yet.

As the following material makes clear, Medicare Part D, is indeed coming January 1, 2006. The bombardment of advertisements and public information campaigns started in October. Voluntary enrollment begins November 15 for Medicare recipients who have until May 15, 2006 to make a decision without penalty. Helping older adults on Medicare decide on which plan, if any, is best for them, is an enormous challenge.

As a community psychiatrist my focus has been on younger, disabled patients who are eligible for both Medicaid and Medicare, so-called Dual Eligibles. Initially Dual Eligibles need make no decisions. By the time you read this, each dual eligible will have been assigned to one of ten low cost Prescription Drug Plans available in Ohio. For Dual Eligibles, these plans have no monthly premium or deductible. They do carry co-pays of $1 for each generic and $3 for each brand name prescription. Dual eligibles can choose to switch plans from month to month. You can learn a great deal on the Medicare website (www. Medicare.gov). I checked out available plans for a hypothetical dual eligible patient prescribed three high cost psychiatric drugs and found 7 plans that would cover those drugs for a monthly cost of the $9 for the co-pays. I am not sure what this would mean if my patient was randomly assigned to one of the other three low cost plans.

Psychiatrists and the rest of our mental health teams will need to be vigilant as Part D unfolds. While the Medicare website is very well constructed, even our patients with internet access are likely to have problems figuring out how to apply it to their circumstances. A couple of points to remember:

• Injectable long acting antipsychotic medications are not covered under Part D. They will be covered under Part B of Medicare. While I have had numerous assurances that there will be no problem covering payment for these physician delivered services, I will believe that when I see it.
  
• Benzodiazepines are excluded from Medicare Part D. Ohio Medicaid will cover benzodiazepines, but there are indications this may be limited to only certain drugs in this class.
  
• Our dual-eligible patients may claim they cannot afford the co-pays. It is not clear how pharmacies will deal with such claims.

I view Part D as a moving target. I appreciate Janet Shaw's hard work to keep the OPA membership informed as answers (and new questions) emerge. Keep reading the electronic newsletter to stay up to date.

Medicare Part D enrollment

Starting January 1, 2006, anyone eligible for Medicare will be provided prescription drug coverage. The "Medicare Part D" prescription drug coverage plan was created in 2003 as part of the Medicare Modernization Act and will help patients who have Medicare Part A (hospital insurance) or Medicare Part B (medical insurance) pay for part of their prescription drugs.

Medicare Part D enrollment began November 15. Those eligible received a notice informing them:

• They will be enrolled in a Medicare Prescription Drug Plan if they don't join one by the end of the year;
  
• What plan Medicare will enroll them in; and
  
• What their cost will be in the plan.

The resources below may help you understand Medicare Part D and help answer your patients' questions.

Resources

Fact sheet on Medicare's auto-enrollment notice:
http://www.cms.hhs.gov/media/press/release.asp?Counter=1705

Series of informative newsletters addressing providers' concerns
http://www.cms.hhs.gov/medlearn/drugcoverage.asp

Plan finder tool training demo
http://media.cms.hhs.gov

Medicare and You 2006 handbook update (new copies of all versions of the Medicare handbook)
http://www.cms.hhs.gov/partnerships

What Medicare Prescription Drug Coverage Means to You: A Guide to Getting Started
http://www.medicare.gov. or call 1-800-MEDICARE

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