Brace for slew of questions about Medicare drug cards

The government is asking doctors to help educate low-income beneficiaries about the credit they can receive to pay for their medications.

By Markian Hawryluk, amednews staff. May 24/31, 2004.

Washington -- As the June 1 start of the Medicare discount drug card program approaches, physicians and their staffs should prepare for a flurry of questions from patients trying to sort through the many options.

Established as a precursor to a full Medicare outpatient drug benefit in 2006, the drug card program seeks to use competitive forces to lower the prices for prescription drugs. Card sponsors negotiate discounts with manufacturers through bulk purchasing and other strategies.

The basics
Mail-order options
Drug reimportation not down or out
Links
See related content

As a result, each card will price its drug choices differently. At press time, the government had approved 72 cards. Medicare beneficiaries must choose the option that best suits their needs based on their medical conditions and the drugs they take. They might turn to their doctors for advice about how to make that decision.

Physician practices can print out copies of the enrollment forms for their patients from Medicare's Web site. Doctors also can point their patients to the Centers for Medicare & Medicaid Services for help. Beneficiaries can get information on the drug cards available in their area by calling the agency's 1-800-MEDICARE hotline or by logging onto the program's Web site. Both will provide seniors with the actual prices they can expect to pay for their prescriptions. Patients can also request a personalized booklet that includes the same information.

Much like the rise of direct-to-consumer advertising, the drug card program could spur more discussions between patients and doctors about medication options. That's because CMS is listing the difference in price between brand-name drugs and generics, and hopes to soon post the price differences between brand-name drugs within a class.

This means Medicare patients might begin to pepper doctors with more questions about generic alternatives and their safety, American Medical Association officials noted.

Medicare's discount drug program starts June 1.

And physicians might soon find themselves fielding more requests for switches in brand-name prescriptions. CMS will focus primarily on drugs in commonly used categories, such as statins, ACE inhibitors and nonsedating antihistamines.

"Drugs like that together account for a large part of drug costs," said CMS Administrator Mark McClellan, MD, PhD. "Millions of beneficiaries may benefit from learning about lower-cost options being made available and may want to talk about it further with their pharmacist, their doctor or another health professional."

The AMA is working to help doctors and patients get ready, said its president, Donald J. Palmisano, MD. The Association plans to send member doctors pocket cards with information on the discount drug cards to help educate their patients and has launched a Web site that details information on the program. The AMA has also suggested that physicians put a sticker or stamp on all Medicare beneficiaries' prescriptions to flag the discount cards' availability.

"[The discount drug card is] an important benefit that gives our neediest citizens greater access to medications," Dr. Palmisano said. "Medically prescribed drugs are a critical part of the practice of medicine. New innovations in medicines allow people to live healthier lives and decrease the need for surgery in many instances."

Extending extra help to poor patients

Physicians are also being enlisted to help get the word out to low-income beneficiaries that they can get a $600 credit on their drug cards each of the next two years.

"One thing that is incontrovertible is that people who have limited incomes now and are struggling between paying for the drugs and paying for their basic necessities of life need to sign up for this program this month," Dr. McClellan said.

More than 70 discount cards have been approved in the Medicare drug program.

The credit is available to individuals with incomes of less than $12,600, or $16,800 per couple. A number of large drug manufacturers are making their medicines available at just a dispensing fee to low-income beneficiaries who have exhausted their credits.

CMS and patient advocacy groups are gearing up for a major outreach campaign to enroll those eligible for the additional benefits. The AMA is part of the Access to Benefits Coalition, a group of health care organizations led by the National Council on Aging that aims to ensure that low-income beneficiaries know about and can make optimal use of the new Medicare prescription drug benefits.

"Unfortunately, the track record of various past efforts to enroll low-income populations in public and private benefits programs has been at best inconsistent and uneven," said NCOA President and CEO James Firman. "Take-up rates for current Medicare low-income benefits are estimated at only 43%. We must do better."

Signs of success

So far, the drug discount program seems to be producing significant savings. A CMS study based on initial drug pricing submitted by card sponsors found that beneficiaries could save between 10% and 17% off the average retail price of prescription drugs paid by all Americans, including those with drug coverage. Savings on generics ran between 30% and 60%, compared with what Americans were paying for generic drugs at retail pharmacies.

The study also countered criticism that seniors could get better discounts through private mail-order options. The Medicare discount cards' mail-order prices compared favorably to these commercial efforts.

The discounts provided by the Medicare drug cards can change from week to week. CMS will only allow cards to raise prices if they can demonstrate an increase in their costs. The agency is also keeping an eye out for bait-and-switch tactics and has threatened to kick drug cards that violate the rules out of the program.

Dr. McClellan said making public the drug pricing data would lead to lower prices as the drug cards compete against each other to enroll seniors. After prices were listed on Medicare's Web site for a week, many of the cards lowered their prices to be more competitive.

"You're definitely seeing more cards offering better discounts this week," Dr. McClellan said on May 10, after the first update of drug prices. "We're seeing a lot of cards that had higher prices last week moving toward the lower end of the competitive prices, getting their prices down through bigger discounts."

ADDITIONAL INFORMATION:

The basics

Medicare drug card discounts begin June 1.
Medicare beneficiaries can enroll in only one card each year.
Card issuers can charge an annual fee of up to $30. Some cards have no fee.
Different cards will offer different prices, so beneficiaries should consider their options.
Discounts are applied at the time of purchase through retail or mail-order pharmacies.
Low-income beneficiaries can get a $600-per-year credit on their discount cards.
Centers for Medicare & Medicaid Services information may suggest a switch to generic or brand-name alternatives to save money.

Mail-order options

Some Medicare discount drug cards include mail-order options that offer a 30-day supply of commonly used drugs at comparable or lower cost than popular wholesale drug stores not affiliated with Medicare. Canadian drug prices remain a cheaper option, although federal officials have raised safety concerns. Some examples:

	Card 1	Card 2	Drugstore.com	Canada
Aricept	$120.97	$119.48	$127.99	$119.04
Celebrex	$105.64	$162.87	$76.99	$38.69
Fosamax	$59.37	$59.37	$64.99	$39.43
Lipitor	$60.85	$66.82	$62.99	$49.85
Nexium	$109.39	$262.87	$120.99	$64.73
Norvasc	$39.32	$44.75	$42.99	$39.43
Plavix	$106.27	$106.27	$114.99	$67.70
Prevacid	$113.51	$132.31	$120.99	$56.54
Protonix	$89.52	$112.26	$98.89	$56.54
Zocor	$111.74	$111.75	$123.99	$63.98

Source: Centers for Medicare & Medicaid Services

Drug reimportation not down or out

Lawmakers opposing reimportation of prescription drugs from Canada and other countries once had hoped that the addition of a prescription benefit and drug cards to Medicare would stifle debate on the issue. Instead, the drumbeat for reimportation seems to be as strong as ever.

Already this year, three new reimportation bills have been introduced in Congress. In what seemed a surprising turnaround, Health and Human Services Secretary Tommy Thompson recently told reporters that reimportation legislation is becoming an inevitability the agency would have to accept. As HHS rolls out the Medicare discount drug cards, it has become apparent that prescriptions filled by Canadian pharmacies could still, in some cases, prove less expensive than those bought with the new cards.

Reimportation also has gained unexpected support from the country's two largest pharmacy chains.

Tom Ryan, CEO of CVS drugstores, recently appeared before the Federal Task Force on Drug Importation to testify that many Americans already are importing drugs, and "we owe it to them to face this issue head-on."

Walgreens officials also said they would support legalization if the government decides it can be done safely.

Meanwhile, states and localities continue to try to help their residents buy cheaper drugs from Canada, mainly through recommended online pharmacies. Also, attorneys general from 18 states recently sent Thompson a letter urging him to authorize states to act as licensed wholesalers to import drugs from Canada.

Pharmaceutical industry representatives maintain that reimportation cannot be done safely and that legalizing the practice will lead to more bogus and tainted medications coming into the country.