So here we are three months into 2006 with this new paradigm called Medicare Part D and I think it is an appropriate time to dissect what has transpired in this calamity.
The Good: We are finally getting paid in a timely and consistent manner on a good portion of our population that was dual-eligible. Formerly these claims were being paid through the Comptroller’s office and now are being paid by the various PDP’s. In fact, there are many patients whose claims for January have been paid BEFORE the claims from December. Proving once again that efficiency in the private sector is vastly superior to that of the public sector.
Say what you will about the current Administration, but in the case of the Senior Care recipients they have tried to do “the right thing” with these folks. It would have been 10 times easier for the State to say goodbye to the Senior Care program and left these folks to fend for themselves (like many other states have done).
Jim Parker. A tip of the Cardinal Cap to you. You faced an angry mob on the first couple of Conference calls but you stayed after the bigger problems and some have seemed to settle down.
One of the smartest moves we made as an organization was opening on January 2. We were able to experience many of the problems without the crush of the “day after a holiday”
The Bad: Where do I begin? I think most of the problems with the new Medicare Part D program can be traced to a few basic problems that just kept recurring thousands of times.
1) An uneducated public. Certainly, this complex of a program could have had a better design. I know that the Social Security Administration, the local Agencies on Aging and many pharmacists made presentations to educate the seniors on this program. But there are too many variables and too many “what ifs” that when you tried to explain the program you only got blank stares. People just wanted to be told what to do and what was best for their particular situation. It was too painstaking of a process to deal one-on-one with millions of people.
2) A lack of awareness of what the recipients should be on the lookout. Would it have been too much to ask for SSA or CMS to demand of the PDP’s to put on the outside of the recipients envelope “THIS IS YOUR PRESCRIPTION DRUG PLAN INFORMATION FOR 2006. YOU MUST TAKE THE LETTER OR CARD TO THE PHARMACY BEFORE GETTING PRESCRPTIONS FILLED IN 2006”
3) PDP’s that were woefully unprepared for the onslaught of problems and resultant phone calls. One of the first adages that we learned in computer class at pharmacy school in 1985 was GIGO. Garbage in garbage out. 20 years later it is still true. Thank you Dr. Bedard.
4) HMO’s that were slow to get information to their recipients and network pharmacies as well as slow getting to the table to co-ordinate with the Illinois Cares Rx program. Once again a lack of timely notification caused a mess at the pharmacy level.
The Ugly: Pacificare seems to top the list here. How this sorry outfit ever got chosen to administer benefits for the State of Illinois is beyond me. Here is the running list:
1) Being put on hold for over an hour and then being cut off so that you could repeat the on-hold routine for another hour.
2) Limited formulary. On Day 1 when diclofenac was not covered I knew there were huge problems.
3) Sending recipients bills for premiums that they did not have to pay. Thank you for another flood of phone calls to the pharmacy for which we had no idea what it was about or why they were getting these. Once we had it figured out then we had to explain it hundreds if not thousands of times. Where is our compensation for that?
4) The demand fax letter that told the pharmacies that if they did not stop charging sales tax that they would terminate our contract. Did their legal and tax department happen to call the Sales Tax unit in Springfield? Illinois is one of the few jurisdictions that charge Sales Tax on Prescriptions and in this case they have not exempted Medicare Part D Sales.
Pacificare here is some unsolicited advice. Before you send out your next notice, think about how this notice will affect operations at the pharmacy level. Once you have figured that out, double check your work for accuracy then stick the idea in a drawer sleep on it and if it still seems right in the morning then do it. Otherwise just stick it….in the drawer.
Todd Evers, RPh