Medicare’s Prescription Drug Plans: What Should You Advise Your Patients?

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The prescription of eyedrops to treat disease is a major part of what ophthalmologists do for patients. The cost of eyedrops can be a significant financial burden in itself but, when coupled with prescription drugs for other diseases, can become overwhelming for many of our patients who do not have generous prescription drug coverage. Brand-name glaucoma medications alone have been estimated to cost $500 per patient per year. A substantial component of our patients’ failure to fill prescriptions may be their inability to pay for their medications. In response to Medicare recipients’ growing need for prescription drug coverage, in 2003 Congress passed the Medicare Modernization Act. Medicare recipients have been eligible to enroll since November 15, 2005, and the programs themselves took effect on January 1, 2006. Our patients have been coming to us, and will continue to come, with questions about the Medicare Prescription Drug Program. It is our responsibility to provide them with the best answers possible. To do this, we ourselves must understand the benefit. This cannot possibly be done in detail in a short editorial, but we can at least make several points that will serve as an introduction to this complex benefit plan. Space limitations preclude a discussion of Medicare patients who also are eligible for Medicaid, so the examples given below cannot be directly applied to them. First, there is not one plan, but many. The plans are not offered by Medicare, but rather by insurance companies and other private companies. These companies negotiate discounts on drug prices with Medicare. In our home state of Maryland, there are 18 insurers offering freestanding Medicare drug plans. These plans differ in their monthly premiums, which drugs are covered, the amount of copayment, and the pharmacies that can be used. Proponents of the number and diversity of these plans argue that vigorous competition among a large number of plans will keep premiums down and keep benefits generous. Critics respond that the complexity of choosing from so many plans may be paralyzing, particularly for the elderly beneficiaries of Medicare. Therefore, to choose rationally, your patients will have to determine the size of the discount from each plan that they will receive for the aggregate of all prescription drugs that they use, and weigh the size of that discount against any extra costs and inconveniences of a given plan. Your patients can get assistance in this complex task from Medicare (http://www.medicare.gov or 1-800-MEDICARE) and from marketing materials from companies who are selling the plans. Undoubtedly, there will be some beneficiaries who will be intimidated by the process and not enroll. Second, the Medicare prescription drug plans will have the same basic structure as most types of insurance. There