What’s to say that this year’s still unsettled Aetna/Coventry Part D snafu won’t be repeated in the 2016 plan year? What assurances should patients have that the Medicare Plan Finder, the government’s plan cost and pharmacy access comparison tool, contains accurate information? Should patients—and the Centers for Medicare & Medicaid Services—just assume that plan sponsors or PBMs aren’t knowingly trying to rig the system, just the way NFL referees assumed that game balls weren’t being purposefully deflated?
Congress created Medicare Part D a decade ago, and now is a good time for it to ask some specific questions and examine if this public-private partnership is operating at maximum efficiency or if it could do even more for seniors. It’s at the micro level where the impact is felt from situations like the one involving Aetna. Many of you could provide examples of your own (and we hope that you will), but here are some that have come to our attention:
A pharmacist in rural Montana serves 25 patients impacted by this situation, some of whom have acute medication needs such as for the flu and mood disorders. The nearest “in-network” pharmacy is 85 miles away in North Dakota.
A Native American in Northern California usually receives his medications for chronic pain and depression from a local tribal clinic pharmacy for $5. That pharmacy is now out of network. He cannot afford the $918 out-of-pocket costs, potentially forcing him to the emergency room for treatment.
A 93-year-old, retired optometrist and veteran had to arrange a special trip to his community pharmacy to switch to a new Medicare drug plan that allowed him to stick with his pharmacy. Accompanied by his caregiver he sat beside the pharmacy counter in his wheelchair while breathing through his oxygen (supplied by the pharmacy) for over an hour on the phone with 1-800-MEDICARE.
These patient calamities are some of the reasons why earlier this week I asked the relevant congressional committees to schedule hearings to carefully investigate the alarming problems seniors have dealt with in the 2015 plan year—some 50,000 affected to some extent—and ensure that nothing like them happen again. The problems recall patient access issues experienced by other Medicare beneficiaries and help further illustrate the need for an effective “any willing pharmacy” policy.
However, Congress needs to hear directly from seniors. As such, NCPA has developed resources available to you to help you engage your patients and encourage their immediate action. These include a bag stuffer as well as a patient letter that can either be printed and mailed or emailed directly to their congressional offices to make their concerns known.
Filed under: General Problems
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