Medicare Express on schedule, but many seniors not boarding

Drug Store News,  Dec 19, 2005  by James Frederick

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WASHINGTON -- The Medicare Express is still on schedule. But many passengers may not be boarding any time soon.

Pushing past a chorus of concerns that the program was too confusing and complex for most people to understand, the Centers for Medicare and Medicaid Services began allowing seniors nationwide to enroll in the Medicare Part D drug benefit program Nov. 15--on schedule.

For the Bush administration, the stakes could hardly be higher, said one, health policy expert. "If there's one domestic accomplishment that will be absolutely critical going into the next election cycle, it's going to be this Medicare plan," said Dan Mendelson, president and founder of health and policy consulting firm Avalere Health. "The president, the secretary [of Health and Human Services, Michael Leavitt] and the other folks in government are going to be judged on the success of this program. There's a lot riding on it for ... the administration and for the folks in the industry."

In the run-up to Nov. 15 and beyond, many pharmacy retailers pitched in with in-store education efforts aimed at clearing up some of the confusion spawned by the program.

Among them:

* CVS Corp., which along with many chains is distributing brochures and promoting its pharmacists as educational resources in the Part D enrollment effort. Under a recently forged partnership with one Part D insurer, Universal American Financial Corp., CVS' PharmaCare division will process claims for the insurer, handle its Part D mail order prescriptions and assume some of the risk for Universal's coverage program for an undisclosed fee.

* Wal-Mart Stores, which has partnered with Humana Corp. both to deliver drug benefits and to educate seniors about their options under Part D. Humana has set up Medicare information booths in most Wal-Mart stores and parked specially equipped trailers in front of some 200 stores where Humana representatives could answer seniors' questions.

* Walgreen Co., which set out Part D information tables staffed with pharmacists and technicians in all of its stores in the weeks prior to the enrollment opening date.

"Having the 'information days' in our stores has helped," Walgreens spokesman Michael Polzin said. In addition, he said, "We had more than 1,400 of our staff going out to seniors' centers and other community gathering places to spread the word on Medicare."

Walgreens, Polzin added, is operating under the assumption that participation in Part D among seniors will "start slowly and gradually build" as awareness about its benefits and the enrollment procedures grows.

In one sense, the official launch of the Part D enrollment period was anticlimactic, because some 6.4 million lower-income dual eligible seniors who qualify for both Medicare and Medicaid are being enrolled automatically. Another 6 million or so beneficiaries are members of Medicare Advantage plans through HMOs and simply can opt to remain in a Medicare Advantage Prescription Drug plan. And many of the 10 million seniors still covered by corporate retirement prescription drug programs are likely to remain in those programs if--and it's a big "if" at this point--those programs remain available.

Nevertheless, that still leaves some 20 million Medicare beneficiaries who could benefit from the Part D program--including some 14 million lower-income retirees who don't qualify for Medicaid, but who stand to gain the most from the new program. And many of those seniors already are looking to their pharmacists for information to help them sort through the confusion.

Seniors enrolling in the program will have their choice from among dozens of drug plans in their region. But they'll have to wade through a thicket of choices about which best suits their needs. That means weighing questions about out-of-pocket costs, premiums, deductibles, varying levels of coverage and drug formularies.

Even lawmakers who have long championed the change in Medicare--which now carries an estimated price tag of more than $720 billion over the next decade--acknowledge its complexity. Compounding the contusion: a much broader-than-expected outpouring of interest in the program from private insurers and pharmacy benefit managers that bid successfully to offer Part D drug coverage through a network of participating retail and mail order pharmacies.

All of those plan sponsors are jostling with one another to sign up Medicare beneficiaries and deliver prescription benefits under contract with CMS.

The result: each of the 34 Medicare drug coverage regions in the United States designated by CMS is now home to dozens of PDP and Medicare Advantage drug plans, all vying to enroll Medicare recipients--particularly the younger and healthier segment of the Medicare population that generates the least amount of drug costs. Some states or multi-state regions offer 50 or more such plans, for a nationwide total of more than 3,000 separate programs. And each of the drug coverage plans available in a region varies in the drug formulary covered, the monthly premium level enrollees must pay, the amount of coverage offered, the level at which coverage reaches its limit at the threshold of the so-called "doughnut hole" before catastrophic coverage kicks in, etc.