Medicare Part D Helpful But Too Complicated

If you and your patients have struggled to make sense of the Medicare Part D prescription drug plan, you're not alone. Two recent surveys of physicians and pharmacists by the Kaiser Family Foundation report that 92 percent of physicians and 91 percent of pharmacists thought the law was too complicated, despite its perceived value in saving money for patients.

Results of the surveys, conducted April 25 through July 8, were released Sept. 7. Of the physician respondents, 17 percent were family physicians and 18 percent were internists.

Although most physicians (71 percent) and pharmacists (86 percent) believe Medicare Part D is helping people on Medicare save money, their opinions about how complicated the program is may stem from the problems their patients have encountered in obtaining prescriptions, according to the survey.

Seven out of 10 physicians said Part D was helping patients with prescription costs, but nearly 60 percent of physicians said they had patients who experienced problems getting their prescriptions filled. Ten percent said they had a patient who suffered a "serious medical consequence" as a result of such problems.

Moreover, 27 percent of responding physicians said helping patients make decisions and get their prescriptions under Medicare Part D resulted in "a lot" of administrative burdens. Among physicians with patients enrolled in Medicare Part D plans, 46 percent said the burdens of dealing with the Part D plans were worse than those associated with commercial insurance.

"We have surveyed seniors many times and now pharmacists and doctors, and the story is remarkably consistent: The benefit is providing help to millions as intended, but there are also problems, and the complexity of the law is an issue for many," said Kaiser Family Foundation President and CEO Drew Altman, Ph.D., in a news release.

Since Medicare Part D launched in January, the AAFP government relations staff has worked with CMS officials and a coalition including the AMA, the American College of Physicians, the American Pharmaceutical Association, the Medicare Rights Center and other organizations to address problems identified in the prescription drug program. Currently, the coalition is developing a standard prior authorization-exceptions-appeals form for all insurance plans.

Susan Hildebrandt, assistant director of the AAFP Division of Government Relations, said, "I was impressed with how the results of this survey -- with a much larger respondent pool -- mirrored the findings of our member survey," she said.

The AAFP Government Relations staff surveyed members in March to determine which Medicare Part D issues most needed resolution. The survey found 52 percent reported finding drugs covered by Part D plan formularies was "very difficult," and 61 percent reported the program was burdensome and time-consuming. At the time of the AAFP survey, 47 percent of Academy members spent five or more hours a week talking with insurance plans about patients' drug coverage.

In response to the 75 percent of AAFP survey respondents who requested a single exceptions and prior authorization form, the Academy and the coalition worked with CMS officials to produce a Medicare Part D Coverage Determination Request form. (PDF file: 1 page / 140 KB. More about PDFs.) Physicians can download and fax the form to Medicare Part D plans to request approval of prescriptions that are not in a plan's formulary, seek prior authorization or request a lower copayment level. CMS regulations require insurance plans to respond to all authorization forms within 72 hours, and the form allows physicians to request an expedited response within 24 hours.

Physicians can augment the request form by completing and including a standard letter (MS Word file: 1 page / 38 KB. More about downloading files.) that includes blanks to fill in for each patient's specific medication issue.

In addition, family physicians can send their complaints about Medicare Part D to the physician regulatory issues team at CMS. The form will go to both CMS and the AAFP Government Relations staff, who are tracking issues members encounter and taking those issues to CMS to negotiate nationwide solutions.

More than 10.4 million Medicare beneficiaries now have a Medicare Part D prescription plan, and 6 million receive drug benefits through a Medicare Advantage plan. Another 21.8 million have drug benefits through retiree or other third-party coverage.