JULY 01, 2004
Daniel A. Hussar, PhD

Medicare outpatient prescription drug coverage is a valid concept and an excellent benefit for those who need it. But the program that has been initiated, with the Medicare Drug Discount Card, is seriously flawed.

The state of Pennsylvania has a prescription drug benefit program for low-income elderly that is known by the acronym PACE (Pharmaceutical Assistance Contract for the Elderly). It is one of a relatively small number of third-party prescription programs that are highly regarded by patients, as well as pharmacists and physicians.

In February, the Pennsylvania Senate Committee on Aging and Youth convened a group of individuals to discuss how the PACE program could be integrated most effectively and simply with the forthcoming Medicare outpatient prescription drug benefit program, and how the PACE program could develop a Medicare drug discount card program that would use federal funds for the benefit of both patients and the state.

Concerned about the complexity and many of the specific provisions of the Medicare drug discount card program, I noted my concern that there would be "chaos" in May when these programs would be marketed by many programs and organizations, many of whom are directly competing with each other. I wish that my observation would have been wrong, but, now that May has come and gone, "chaos" must be considered an understatement.

There were some provisions of the Medicare drug discount card program that I did not fully understand. There were 2 provisions, however, that I thought I clearly understood— the first being that Medicare beneficiaries would be able to make a choice from at least several programs and, second, that an individual could participate in only 1 program (ie, have 1 discount card). I was wrong, as I learned from the very frustrating experience of trying to help my 90-year-old mother translate the communications she received.

My mother is a participant in the PACE prescription program, and she received a letter saying that she would be enrolled in the Medicare drug discount card program offered on behalf of PACE, unless she chose to decline it. This appeared to be a very logical and simple step. My mother, however, has medical coverage (ie, physicians, hospitalization), but not prescription coverage (because she has that with PACE) in a Medicare managed care plan offered by Blue Cross. She received a letter from Blue Cross informing her that she would be enrolled in its Medicare drug discount card program unless she chose to decline it. So at this point, my mother had been informed that she is being automatically enrolled in not just 1 but 2 programs.

The course of action still seemed clear—she would decline participation in the Blue Cross discount card program and be enrolled in the PACE discount card program. Yet, the letter from Blue Cross included a statement that, if the individual did not participate in its discount card program, he or she was not eligible to enroll in any other discount card program. I was certain that this could not be accurate because my mother is not a participant in a Blue Cross prescription program, and such a requirement would remove any option for choice among the available programs, which I understood to be an important component of the Medicare legislation.

My attempts to obtain clarification from the Blue Cross Member Services Department were an exercise in futility. After reaching a supervisor, I was told that the personnel had not been provided direction with respect to my questions and that I would need to call back.

When I called back, I had to persist to speak to the same supervisor, and, once I did, I learned that there were still no answers but that she would call me back soon. I provided my phone number and asked for the phone number at which I could reach her directly. She refused to provide it. She did call back a short time later, not with answers, but with a response that a letter should arrive soon that would have the information I requested.

Several days later, my mother received a letter from PACE that essentially said that the insurance company managed care program discount card takes precedence over PACE's discount card. In other words, she does not have a choice between programs, but rather her only choice is whether to accept or decline the Blue Cross discount card. She is continuing in the PACE prescription program and, therefore, has declined the Blue Cross card. The end result of all this is no choice and no discount card! I continue to persist in trying to obtain answers and resolutions.

The Medicare drug discount card program was poorly designed, and the chaos in implementing it was predictable. The elderly have been betrayed! The profession of pharmacy was able to have very little influence on the Medicare prescription drug legislation, and matters could go from bad to worse between now and when the prescription drug benefit is fully implemented in 2006.

Our profession should establish our own PBM that would provide a superior prescription drug and services benefit program. I believe that such a program could be created that would be financially competitive with existing programs.

What we need now from within our profession are strong leadership, the willingness of our organizations to work in a unified manner, and more active support and involvement from within the profession, particularly pharmacists in community and long-term care practice settings.

We are fortunate in that a comprehensive prescription and pharmacy services program that will best serve elderly patients also will serve our profession well. The elderly and their organizations can be a powerful ally for pharmacy. The goals are formidable, but I believe that they are attainable.

Dr. Hussar is Remington Professor of Pharmacy at the Philadelphia College of Pharmacy, University of the Sciences in Philadelphia.