Published May 1, 2006 | May 2006 issue
These [pharmacy benefit managers] have not been paying in a timely fashion, so it certainly has caused a cash flow issue for my pharmacy. … The actual profit margin under Medicare Part D is reduced dramatically. So some independent pharmacies are going to be in trouble of survival under the Medicare Part D. ... You combine that with increased overhead for administration or for trying to assist the seniors and having to put on more staff or dedicate more staff to troubleshooting all these problematic claims, then you can see it's not good. … Basically, the financial gain is with the [pharmacy benefit managers] and with the drug companies who really are providing no health care.
Kent Jenema, Owner
Peninsula Pharmacy—Marquette, Mich.
In my view, it's unfortunate that Medicare has made the prescription drug program so complex, because it's actually being such a helpful program. … Depending on what prescription drug people are taking, there might be one plan that's really beneficial for half their drugs and another plan that's beneficial for the other half, but no single plan. … [Insurance partners] have designed plans that leave a lot to be desired. … If you're dealing with people who are 70 or 80 years old, and you're expecting them to do things online or expecting them to do things with telephone menu systems, forget it.
Charles Aagenes, Director
Area IV Agency on Aging—Helena, Mont.
It really hasn't affected our clinic provider fees or schedule business, because we don't do the drugs. … I have noticed some of our patients have switched from Medicare to some other insurances. They're not using Medicare anymore [due to confusion]. ... None of them have come up and actually stated that to me, but they're saying, "We're switching from Medicare to some other insurance that takes the place of Medicare." That didn't make sense to me, but I suppose that if that other insurance company is going to give them some more clear direction, yeah, I'd go for them too.
Shawna Zastoupil, Biller coder
Pneumos Clinic—Bismarck, N.D.
The decision to automatically enroll 7 million dual-eligibles [eligible for both Medicare and Medicaid] effective January 1 was a big mistake. … They went from a Medicaid drug program that was mature and working well to dozens of Part D plans, many of which were clearly unprepared for this population. … One thing that's happening is enrollment in our SeniorCare [Wisconsin's prescription drug assistance program] has gone up about 10 percent since the governor announced it was going to be retained at least through June 30. So I think people are clearly demonstrating a preference for that, and it works far better; it's a far better plan.
Mark Moody, Medicaid Director
Wisconsin Department of Health
and Family Services—Madison, Wis.
Despite all the challenges with the new program, we know that many Minnesotans are signing up and actually saving money. But many seniors are still confused by the process and have yet to make a decision. …We have been driving folks to the Senior LinkAge Line, our state-run, impartial source of enrollment assistance. More people need to be aware that extra help is available to pay for the costs of the program for people with limited incomes. These are the beneficiaries who have the greatest need for coverage—and who stand to benefit the most.
Hubert H. "Skip" Humphrey III, State President
AARP Minnesota—St. Paul, Minn.
I think it put a lot of the implementation on the backs of the pharmacists. There were people who had no ID numbers, couldn't be found in the Medicare system. … With no information to go on, a lot of pharmacists, our pharmacy included and most of the pharmacies I know, they were handing out medication to people because they didn't want them to go without, not knowing whether we were going to get paid or not. … I think the Medicare system and Health and Human Services and the third parties that are administering the plans were very ill-prepared for the rollout, and that left a lot of pharmacists and patients hanging.
Julie Meintsma, Retail pharmacist and President
South Dakota Pharmacists Association—Pierre, S.D.