The establishment of the Medicare Part D and Advantage programs in 2006 significantly decreased the cost of medicines for millions of Medicare beneficiaries. Despite this, the cost of medications can still be a significant barrier for many patients who are on a fixed income or who might be taking multiple, sometimes expensive drugs. This cost barrier can affect health outcomes, so if a patient has less expensive drugs, lower premiums, and lower copays, then prescription adherence and health outcomes may improve.
Medicare Advantage and Medicare Part D plans might provide a solution for your patients, and open enrollment, which runs from Oct. 15 through Dec. 7, allows Medicare patients an opportunity to change plans or sign up for the first time if they are not already in a program. However, the out-of-pocket costs for specific medicines for a patient on Medicare Part D or Medicare Advantage can vary significantly from 1 plan to the next. Patients with 1 or more chronic diseases could achieve significant savings by choosing plans based on the specific drugs they take. A 2012 study published by Health Affairs showed that the mean savings for a Medicare D enrollee is $368 per year.
Now, there are tools that can help patients enroll or switch among Medicare plans. The Medicare Plan Finder is an interactive tool that allows users to answer a few basic questions, such as ZIP code, type of Medicare they have, and medicines they currently take, and get a detailed report showing the estimated out-of-pocket costs (premiums, copays, deductibles, and in- or out-of-network drug prices) for all of the available Medicare Part D and Advantage plans. A series of instructional videos on the Plan Finder homepage explains how to use this tool.
An ACP member, Steven L. Cohen, MD, has helped his Medicare patients use this tool, as well as his younger patients who want to help their older relatives find a more affordable plan. One of his patients saved $31,000 a year in drug costs with this online tool.
Practices can help by making their patients (and their caregivers) aware of these resources. Practices can provide patients with a list of their medications and dosing and a handout that explains how to find the tool and how it works. Dr. Cohen has created a printable guide including screenshots to help patients search for a new plan, available online. Another option is to have a staff member or intern show less tech-savvy patients how to use the tool on a laptop or tablet. The practice can also use its website or social media to point to the resources.
There is another point that practices should consider: Because some plans require using certain pharmacies, it is important to make sure that the participating pharmacies are acceptable to the patient. For example, in some cases, the biggest savings can be obtained by using mail-order pharmacies, which may or may not be manageable for some elderly patients.