Sunday, January 04, 2004

This evening I ran across an interesting article in the New York Times on-line edition.  This is a discussion of some of the recent changes in the Medicare law, specifically, those pertaining to prescription drugs. 

January 4, 2004
State Officials Are Cautious on Medicare Drug Benefit

One of the most important points in this article is that some of the consequences of the new legislation have not been thought through carefully.  The following quotes illustrate this:  

¶Steven J. Rauschenberger, the assistant Republican leader of the Illinois Senate, said Congress had not paid enough attention to the efforts of states.

¶"Instead of emphasizing the good work being done by states and encouraging states to continue, the federal government came up with a one-size-fits-all Potomac solution," Mr. Rauschenberger said.

¶Thomas M. Snedden, director of the Pennsylvania program, welcomed the expansion of Medicare but said he foresaw immense problems coordinating its drug benefit with the popular state program.

¶"Customers used to getting a prescription drug covered with a co-payment of $6 will now be told that they owe $100 because the drug is not covered by their Medicare plan," Mr. Snedden said.

¶These officials, still struggling to understand the federal law, predict that many beneficiaries will be confused as longstanding arrangements are disrupted and replaced with private Medicare plans offering different packages of drug benefits under different sets of rules.

I will venture to predict some of the undesirable outcomes from this legislation.  Not only will there be confusion within state government, but also among patients and physicians.  Pharmacies will be caught  in the cross fire.  There will be a number of instances of patients being harmed.  For example, patients who have been stabilized on one medication was suddenly find it that medication is no longer covered.  They will face a choice between paying a large amount of money out of of their own pocket, or switching to a different medication.  Physicians will write prescriptions thinking that they will be covered, but when the patients get to the pharmacy it will find that they are not.  Pharmacist will dispense medications, thinking that they will be covered, only to be stuck with the cost when the medications in fact a not covered.  These things will happen as result of patients being switched from one prescription plan to another.  There will be cases in which patients are told to discontinue drug A and to start drug B.  They will go to the pharmacy and find that prescription for drug B is is not covered.  They will no longer have drug A, had not having been given a prescription for it.  This kind of scenario will result in many frantic.  calls to the physicians office.  Medication errors will result; or in some cases, patients will simply have to go without medication until the problem is straightened out.

I would like to suggest that any officials involved in planning the transformation from the current situation to the new situation, consider carefully a transition plan that will help prevent these kinds of problems.  They also hope there will consider increasing reimbursement to physicians and pharmacies to cover the extra costs that this confusion will entail.  I also would like to suggest that the FDA began thinking about steps that they may be will to take to help reduce medication dispensing errors.  Also, I hope that the medical establishment will put into place continuing education programs to help physicians understand how to manage some of the complex, pharmacological issues that will arise from constantly-changing, restricted formularies.