In the Wake of Part D, A Big Thank-You

MARCH 01, 2006
Fred M. Eckel, RPh, MS; Pharmacy Times Editor-in-Chief

It is time to say thanks to all of you who have worked so hard to help people through the painful transition to Medicare Part D Prescription Drug plans. It is largely due to the work of dedicated pharmacists that many thousands of people have continued to receive their medications despite a system in chaos.

When introducing a program of such an unprecedented scale, some problems are inevitable. Many of the issues, however, stemmed directly from the approach taken by the companies responsible for the new prescription plans.

First, insurers and pharmacy benefit managers (PBMs) were very poorly prepared for the surge in call volume. Some PBMs apparently were so swamped that their representatives could not answer the phone at all; in other cases, wait times stretched out to an hour or more. As a result, dedicated pharmacists and technicians sometimes spent entire days trying, and sometimes failing, to help just a tiny handful of people. For some, the process got a little smoother as the weeks went by, and the Centers for Medicare & Medicaid Services, and then the insurers, gradually worked out some of the problems.

That was not the only issue, however.To help people desperately in need of medications, some pharmacists provided drugs, more or less free, even when they were not able to reach PBMs and insurers to verify that the people were covered. Perhaps even more pharmacists would have been prepared to hand out drugs worth hundreds of dollars if they had been more confident that PBMs would protect them by reimbursing them. Unfortunately, many pharmacists do not trust PBMs.

Even in cases where they have been able to reach insurers and verify coverage, some pharmacists have been left with an uneasy feeling about reimbursement by overloaded insurers and PBMs. Any delays in reimbursement will hurt pharmacies whose business is already suffering from the extra unpaid work the pharmacists have put in on behalf of Medicare recipients. Overall, the problems with Medicare Part D are increasing the pressure on hard-pressed community pharmacists who already worry about whether they will able to stay in business at all. Now is the time for insurers to respond quickly to pharmacists who have done so much to make the system work.

For now, though, once again, here is a big thank-you to all who have helped people through this transition—for the countless hours of extra work, for your commitment to your customers, for helping keep the supply lines open. We all know that pharmacists play a vital, yet underappreciated role. Perhaps, as a result of your actions during this health care crisis, more people will come to understand the value of the pharmacist.

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.