Physicians Practice - March 2008 - (Page 85)

CME HEALTHONOMICS HANDLING THE CHANGES WROUGHT BY MEDICARE D BY SUZ REDFEARN, BA YOU’VE ALWAYS HAD DIFFICULTY WITH DRUG FORMULARIES, BUT MEDICARE’S NEW PRESCRIPTION PROGRAM CREATES A FRESH SET OF PROBLEMS Many things have changed at Jim King’s Selmer, Tenn., practice since the 2003 advent of Medicare Part D, Medicare’s prescription drug beneﬁt. For one thing, King, president of the American Academy of Family Physicians (AAFP), now makes a pointed effort to talk to his patients about whether they are actually taking their medications, especially during the last few months of the year. Because of the signiﬁcant coverage gap — known as “the donut hole” — that Part D recipients experience after reaching about $2,100 in covered drug expenditures in any given year, many of King’s patients can no longer afford their drugs by November and December or even earlier. Often, they silently just go without. “Patients won’t get their prescriptions ﬁlled, and they don’t tell us,” says King, one of seven family physi- LEARNING OBJECTIVES After reading this article, readers will be able to: • Recognize the added responsibilities • Identify a variety of effective and considerations physicians now have as a result of Medicare Part D. techniques for keeping track of plan formularies and appealing to plans on behalf of patients. Medicare D patients prepare for and limit coverage gaps at the end of the year. • Implement solutions to help cians at Primecare Medical Center. “They can’t pay for it out of pocket, and they are embarrassed. Now we tell them before they leave: ‘If you have problems getting your medicines, call us. We will help.’” That’s another thing that’s changed: King — almost 30 percent of whose patients have Medicare — now stockpiles the samples that pharmaceutical salespeople leave so his practice can give them to Part D recipients who need them at the end of the year. Another change? King has gotten tight with the local pharmacist. That’s because he’s on the phone with him so much now. The pharmacist calls to say a patient’s drug isn’t covered under a particular Part D plan (most markets have about 50 such plans, each with a different formulary), and would King like to discuss generic equivalents? Then, of course, there’s all the extra time spent arguing with Part D plans, trying to make the case that a senior absolutely needs a drug that the plan doesn’t want to cover. “We spend a lot of time jumping through hoops, faxing paperwork, being on hold,” King says. The result: much of his patients’ visits are spent not on patient-care matters, but on managing their Part D plans’ requirements so that their bodies — and pocketbooks — can cope. King is certainly not alone. Any practice that has Medicare patients has gone through some uncomfortable shifts lately thanks to the arrival of Medicare Part D, which has helped seniors get at least some of their drugs covered now, but has been trying for doctors, as it imposes a restrictive managed care-type structure on prescribing. MARCH 2008 | PHYSICIANS PRACTICE | WWW.PHYSICIANSPRACTICE.COM 85 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - March 2008

Physicians Practice - March 2008 Contents The Bigger Picture: Try a Little Tenderness Second Opinion Letters Physicians Practice Pearls: The Value of First Impressions Noteworthy Cover Story: Your Complete Guide to Patient Service Billings & Collections: Rules to Code By The Administrators Desk: Selecting an EMR Technology: Learn to Love Your Nerd Ask The Experts Coding The Guide The Tech Doctor: All About Blogs The Great Practice Makeover: When Bad Things Happen to Good Practices Start It Up - NEW! The Law: Audits 101 In Practice: Do As I Say... Pretty Please? Healthonomics: Handling the Changes Wrought by Medicare D Classifieds Advertiser Index

Physicians Practice - March 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.