Medicare Part D's approach stirs unease

With only three months to D-Day, as in Medicare Part D, many unanswered questions about how the prescription drug program will be implemented and how it will impact pharmacy are causing a lot of unease, according to members of the Drug Topics Editorial Advisory Board.

Drug formularies, medication therapy management (MTM) services, reimbursement rates, and the mandatory switching of Medicaid patients over to Medicare are just some of the issues that are still hanging over pharmacy's head. And trying to get answers out of the Centers for Medicare & Medicaid Services is tough because the agency doesn't seem to have all the answers, said several members of our advisory board at a recent Medicare Part D roundtable in New York City.

Don't hold your breath

Many in pharmacy latched onto MTM services as the profession's best chance to squeeze lemonade from the Medicare Part D lemons. But the reality is that pharmacists may not be utilized, at least in the short run, said some members of our panel.

Since there's so much uncertainty about MTM programs, the PDPs will simply leverage their in-house clinical programs at first, said David Fong, Pharm.D., senior VP of pharmacy and family care, Safeway Inc. "The level and scope of involvement by pharmacy is still unclear," he said. "With the complexity and scope of these Medicare drug benefit offerings, the plans are just trying to get ready. We expect that plans will continue to discuss and evaluate different pharmacy MTM services over the next six months."

While pharmacists are not being actively pursued to deliver MTM services, the profession still needs to step up, get involved, and educate the public, said Fong. "Several pharmacy organizations are getting ready, which is the right thing to do," he said. "There will be a lot of confusion about the program, and pharmacy will be expected to have the information and guidance for these seniors. We must not disappoint them."

Early on, many people thought MTM would impact pharmacy, and there was a huge push to have programs put together by New Year's Day, said Phil Burgess, R.Ph., national director, pharmacy affairs, Walgreen Co. But that's not going to happen because CMS first has to find out who is eligible for the program.

"They don't really envision that happening until the summer or even the fall of 2006," Burgess said. "It may not sound like a big deal, but a lot of us were scrambling to have everything in place by Jan. 1, but that's not the criterion now."

People will die

Drug plan formularies coupled with the mandatory enrollment of Medicaid patients in Medicare are going to play havoc with patient care, according to Fred Mayer, R.Ph., president of the nonprofit Pharmacists Planning Service Inc., San Rafael, Calif. He's worried that in the short transition period between the time Medicaid coverage ends and the Medicare benefit begins, hundreds of thousands of these so-called dual eligibles are not going to get their drugs because they'll fall through the cracks.

"We've been saying that there will be a bunch of deaths, because there's nobody to do oversight of the dual eligibles," said Mayer. "There are seven million of them-the sickest of the sick. Our consumer groups have had seven meetings with CMS. When we talk about these dual-eligible and formulary issues, they don't know anything. It's a mess."