Call Summary

Medicare Network Conference Call

March 19, 2003

Counseling Medicare Beneficiaries on Access to Prescription Drugs

I.          Introduction

The subject of the March Medicare Network Conference Call was counseling Medicare beneficiaries on accessing prescription drugs. The call was structured around five broad topics: using web-based resources, training a corps of specialized SHIP counselors, obtaining cooperation from beneficiaries’ treating physicians, counseling about drug discount cards, and importation from other countries. The call concluded with an overview of contemporaneous Congressional proposals.

II.        Using Web Based Resources

Call participants identified a variety of web-based resources they commonly use to support counseling Medicare beneficiaries. Many prefer www.Needymeds.com because it is simple to use and does not require as much information as other sites. However, www.benefitscheckuprx.org was preferred for those with the time and information needed to make use of Benefits Check Up. While time-consuming, due to inputting the detailed demographic information required to obtain state-based eligibility information, its results are more comprehensive. Other resources used by SHIPs were the drug locator feature on www.Medicare.gov and a Pharma Web site, www.helpingpatients.org (To find out more about the Pharma Web site, click here or go to http://www.helpingpatients.org/about/.) In a report, Prescription Drug Web Site resources, the Health Assistance Partnership has analyzed the information required for navigation of these Web sites and the formularies used by them. Click here for our report, or check the Medicare page on our Web site www.hapnetwork.org.

Most SHIPs use web-based resources when counseling from their offices.  In the field, such as at senior centers, Internet access is not usually available, and beneficiaries seen there for counseling often do not have all of the requisite information needed to use these sites. In some states, SHIP coordinators send links to the Web sites to computer-literate volunteer counselors or directly to beneficiaries or their families.

Some states have established either government or nonprofit resources to help beneficiaries apply for pharmaceutical company indigent drug programs.  In Maryland, Medbank serves this function and uses www.benefitscheckuprx.org. Many states produce booklets for Medicare beneficiaries explaining drug discount benefits and drug company indigent drug programs. Nevada and Washington State have similar programs. 

The Medicare Rights Center has posted a listing of all state drug benefit programs. The New York SHIP makes use of this matrix.  Click here for the link. http://www.medicarerights.org/rxframeset.html.

III.       Specialized Counselors and Cooperation From Physicians

In some states, such as Michigan, New York, Nevada, Pennsylvania, and Iowa, some counselors specialize in drug benefit counseling. They help beneficiaries to complete application forms and submit them. Many call participants noted that it has become increasingly difficult to obtain the cooperation of physicians, who often must complete and submit documentation in order for their patients to obtain discounted drug benefits. Even when the SHIP counselor fully completes the form so that the doctor only needs to sign and sends it in, SHIPs are encountering increasing resistance from physicians. In some states, the SHIPs has reached out to medical societies, but even in those states, SHIPs have not experienced a significant increase in physician participation.

Some participants suggested that arrangements between physicians and pharmaceutical companies may influence physician behavior in this regard. One state SHIP reported that the legislature considered a bill limiting pharmaceutical company financial arrangements with physicians, but the bill did not pass.

IV.       Drug Discount Cards

Many states have developed booklets describing available state prescription drug benefits and many prescription drug discount card programs. One state includes the drug booklet with its Medigap material.  Some states have developed cautionary materials about drug discount cards.  In New York, the Office of the Attorney General has an online pamphlet that explains the pros and cons of such cards. Click here to see it http://www.oag.state.ny.us/consumer/discount_rx_brochure.pdf. 

Several SHIPs noted that some studies have concluded that locally owned pharmacies often offer deeper discounts due to accepting a lower profit margin than the chain stores. Please contact Hilary at hdalin@healthassistancepartnership.org if you would like to share such reports. Here is a Consumer Report article, "Saving Money on Prescription Medications", descriptions on how to save money on prescription drugs: http://www.consumerreports.org/main/detailv2.jsp?CONTENT%3C%3Ecnt_id=21751&FOLDER%3C%3Efolder_id=21135&bmUID=1053448364651.    

V.         Drug Importation

There was a lively discussion of the pros and cons of importing drugs from other countries, especially Mexico and Canada. Most SHIPs expressed concerns about safety, and many questions were raised about the legality of filling prescriptions abroad for importation to this country. HAP contunues to follow this very complex and sensitive issue.

VI.       Congressional Proposals

The administration has proposed radical changes to the structure of the Medicare program. The President’s proposal would institute a three-level Medicare system. It would preserve the current Traditional Medicare program. Those who remain in Traditional Medicare would be offered a Medicare-endorsed drug discount card, and low-income beneficiaries would get a $600 credit loaded onto the discount card. A second tier of Medicare would be modeled after the Federal Employees Health Benefit Plan, or FEHBP. To see the Families USA Summary Brief, Why FEHBP Isn’t a Good Option for Medicare (March, 2003), comparing FEHBP to Medicare, click here http://www.familiesusa.org/site/DocServer/FEHB_Issue_Brief.pdf?docID=316.

The third tier of Medicare, called Medicare Advance, would resemble Medicare + Choice.

The administration announced that it was leaving the detailed program design to Congress, and the debate on Medicare will take place later during the Congressional session.

For additional information on the Medicare debate in Congress, see the Medicare Central feature on the homepage of the Families USA Web site www.familiesusa.org for up-to-date information on legislative developments.  The Kaiser Family Foundation posts reports on Medicare developments at http://www.kff.org/sections.cgi?section=medicare. Up-to-the-minute reports and web-casts of Congressional hearings on Medicare and other health-related topics are available FREE on the Kaiser Family Foundation web-cast site at http://www.kaisernetwork.org/. 

The AARP Public Policy Institute has published "Medicare Beneficiaries and Prescription Drugs: Costs and Coverage" (September, 2002), http://research.aarp.org/health/dd77_rx.html. Two related pieces from AARP are “What Share of Beneficiaries’ Total Health Care Costs Does Medicare Pay? (September, 2002),  http://research.aarp.org/health/dd78_costs.html and The Status of the Medicare Part A and Part B Trust Funds: The Trustees 2003 Annual Report (March, 2003), http://research.aarp.org/health/dd87_medicare.html.

VII.     Announcements

a.   April Medicare Network Conference Call

The next Medicare Network conference call is scheduled for April 18, 2003 at 3:00 P.M. EST. The topic will be “When retiree health insurance disappears” and will address COBRA and Medigap options for retirees whose companies discontinue retiree health insurance benefits.

b.   The QI-1 benefit

The QI-1 benefit has been extended through September 30, 2003, the end of the federal fiscal year. The president’s FY 2004 proposed budget includes funding for QI-1.  The QI-2 Program expired on December 31, 2002 and was not renewed by Congress.

c.   Report on the future of Medicare

The National Association for Social Insurance has released a report entitled Medicare in the 21st Century (March, 2003).  This thoughtful analysis makes for interesting reading and SHIPs may wish to see it.  It is available at http://www.nasi.org/publications2763/publications_show.htm?doc_id=146189. This report is a part of a larger compilation of Medicare reports developed by the National Association for Social Insurance entitled Restructuring Medicare: A Synthesis of NASI Medicare Projects, (Medicare Brief # 9, March, 2003,) at http://www.nasi.org/publications2763/publications_show.htm?doc_id=164620.

d.   Fiscal Cap on Medicare Coverage of Outpatient Rehabilitation Therapy Reinstated

The cap on Medicare coverage of outpatient physical and occupational therapy is scheduled to be reinstated as of July 1, 2003. The cap will not apply to services provided by hospital outout patient rehabilitation facilities (CORFs), and Medicare Part B services delivered to nursing home residents whose stay is not covered by Medicare Part A. For more information, see  http://cms.hhs.gov/manuals/pm_trans/AB03073.pdf and http://cms.hhs.gov/manuals/pm_trans/ab03018.pdf.

For background information on the therapy caps, see the report of CMS to Congress on the effect of the cap on Medicare reimbursement for outpatient therapy at http://www.cms.hhs.gov/medlearn/therapy/execsumy.pdf.

VIII.    For more information from HAP

Please contact Hilary hdalin@healthassistancepartnership.org or call (202) 737-6340 with your comments questions or suggestions.