Medicare drug plans give docs a headache
Doctors deal with so many different plans and drug lists in the program that they have trouble deciphering coverage
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About one in five Medicare beneficiaries who previously had no prescription drug coverage now receive benefits under the Medicare Part D program, yet some still leave the pharmacy without medicine.
The problem is pointed out in a study of the 1,900 Medicare drug plans and their approved drug lists by a research team led by Dr. Chien-Wen Tseng of the Pacific Health Research Institute and UH's John A. Burns School of Medicine.
The problem, she says, is there are so many plans and different drug lists that doctors have difficulty knowing which drug to prescribe for a patient. Her team's findings point the way to a solution.
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Doctors across the country are dealing with so many different plans and drug lists in Medicare's prescription drug program that they have trouble knowing which drugs are covered, says a Hawaii researcher.
The huge number of plans "makes it difficult to figure out which drugs actually are paid for," said Dr. Chien-Wen Tseng, Pacific Health Research Institute investigator and University of Hawaii John A. Burns School of Medicine professor.
Tseng gave this example: A doctor may prescribe the drug losartin for high blood pressure, but it turns out that drug is not covered by the patient's Part D plan.
However, at a low copayment, the patient's plan does cover another drug, irbesartan, which is likely to work as well. Right now, there is no easy way for the doctor to know to prescribe the second drug rather than the first.
As a result, she said, doctors unintentionally prescribe drugs not covered by a patient's plan or have a high copayment the patient can't afford.
A Kaiser Family Foundation study found one in nine Medicare beneficiaries with Part D drug plans left without filling a prescription because it wasn't covered or was too expensive, she said.
However, Tseng and a team of researchers studying the plans and different drug formularies found a potential solution to help doctors sort through the plans and drug lists: an electronic list of covered, affordable medicines.
Research assistant Luella Manlucu, in the Department of Family Medicine and Community Health, collected data for the study, reported in the June 20 issue of the Journal of the American Medical Association.
According to the findings, two-thirds of doctors said they aren't familiar with the Part D formularies, or lists of drugs, and three-fourths said druggists or patients have asked them to change a prescription to a drug covered by a plan.
About 23 million Medicare beneficiaries are enrolled in nearly 1,900 Medicare Part D drug plans, which vary widely in their approved lists of drugs, Tseng said.
Tseng and her investigators analyzed all nationwide and statewide Part D plans but focused on 43 plans that are valid in Hawaii and 72 that are valid in California.
From March 1 to April 15, they used the Medicare Web site to cross-reference drugs covered by the plans in eight treatment classes for high cholesterol, high blood pressure, hypertension and depression.
The team studied 152 commonly used drugs, finding some plans covered fewer than 65 percent while others covered more than 95 percent.
They found seven of the eight treatment classes had one or more widely covered drugs with copayments ranging from $15 to $35. Overall, 73 percent of generic drugs and 6 percent of brand-name drugs were widely covered, the researchers found.
Multiple drugs potentially could work for most patients, Tseng said, adding, "Doctors would be happy choosing one that is covered rather than unintentionally choosing one that isn't.
"To us, a practical solution is this list of widely covered drugs be made available to providers, such as on a Web site or hand-held PDA (personal digital assistant) or e-prescribing software and updated regularly to make it easier to figure out when a drug is likely to be covered and affordable for patients."
"It's doable," she said, adding that it wouldn't tell doctors what to prescribe but help them figure out which medications are more likely to be covered and affordable so they could discuss options and costs with patients before writing a prescription.
"Doctors really want to do the right thing for their patients," she said. "Right now, each doctor is having to do this on their own by trial and error. They guess because they can't put all this information together for themselves."
As part of her research, Tseng is recruiting physicians for a pilot project to test a prescribing guide for commercial, non-Part D formularies to see if it's helpful. About 160 doctors are participating thus far and she invites others who are interested to contact her.
