Pharmacies Prepare for Start of Medicare Drug Plan

By Tami Luhby, Newsday, Melville, N.Y.

Dec. 29–Pharmacists may have to stock up on extra Tylenol next week … for themselves.

That’s because the new Medicare drug plan kicks in on Sunday, and pharmacists are expecting a deluge of questions and concerns from confused customers.

Among those senior citizens likely to face the biggest changes — and raise the biggest ruckus — are those who are also on Medicaid. These so-called “dual-eligible” recipients will be automatically enrolled in a drug plan as of Jan. 1 if they do not choose one themselves.

This means that people who are used to going to any pharmacy and paying a maximum of $3 for any drug may all of a sudden be told their medication is not covered under their new Medicare Part D insurance. Also, they will no longer be able to get the pills for free if they can’t afford even the modest co-payment. And in some cases, they may find their drugstore isn’t included in the drug plan to which they have been assigned.

Pharmacists will be the ones to break this news and try to help these customers get the prescriptions they need.

“We expect major chaos at most pharmacies,” said Robert Hayes, president of the Medicare Rights Center, a national consumer service group based in Manhattan. “The plans were randomly assigned to people. No consideration was given in the assignment to whether the plan covers the drugs the person takes.”

Although most senior citizens have the option of picking a Medicare drug plan or forgoing coverage, the 6.4 million elderly residents also eligible for Medicaid have no choice. Their current benefits will end Dec. 31.

But picking a plan is not an easy decision, experts say. New Yorkers must choose among 44 different plans, and those on Medicaid must select from 16. There are about 605,000 dual-eligible seniors in the state.

So pharmacists say they are gearing up to deal with a flood of frustration and fear from customers. Compounding the problem, some say, is they themselves aren’t sure of the new rules.

“It’s going to be tough,” said pharmacist Bryan McCutcheon, owner of Echo Pharmacy in Miller Place. “We’ll probably have to spend a lot more time on the phone with doctors to see if they can switch drugs.”

Most druggists will have to depend heavily on their computers to determine coverage. That does not sit well with Bob Drucker, chief executive of RxUSA, a Port Washington-based mail-order drug company that also operates a retail pharmacy in Jamaica.

“Our computer is ultimately going to be the arbiter of whether we fill it or don’t fill it … because no one can figure out this maze,” Drucker said. The pharmacists “don’t have the faintest idea of what’s going to happen next week.”

CVS, the nation’s largest retail pharmacy chain, has worked with the federal Center for Medicare and Medicaid Services to update its systems to be able to tell its dual-eligible customers which plan they are in and which drugs are covered, said company spokesman Mike DeAngelis. If the plan does not meet their needs, employees can show clients which may be more suitable. Dual-eligible participants can change plans once a month without penalty.

“They are all prepared to assist customers and to help them find a plan that works best for them,” DeAngelis said.

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