One more flaw in the Medicare Prescription Drug Program
Some readers may recall my posts back in April or May on the idiocies of the new Medicare Part D prescription drug program. Well, I've just learned about one more -- or at least I suspect I have.
Here in New Jersey, regulations require all drugs dispersed through nursing care facilities, such as hospitals, nursing homes, and other similar institutions, to be purchased by the facility itself. We learned this when my mother first moved into a nursing care facility here. At first, when she needed prescription drugs, we took the prescription to our own pharmacy and purchased the drugs there, and, for awhile, she was able to take her own medications. However, her Altzheimer's soon progressed to the point where she was missing her meds, or worse still, over medicating. It was at that point that the home advised us that if we wanted their nurses to distribute meds to Mom, they had to be purchased by the home through the pharmacy with which the home had contracted.
I assume the State regulations requiring this are intended to minimize dosing mistakes, and they probably make sense. Indeed, they may not be unique to New Jersey.
In any event, because of that, we are "locked in" to buying drugs through the pharmacy chosen by the nursing care facility.
Along comes Medicare Part D. As you may recall, each insurance vendor participating in the program has its own list of accepted pharmacies, which the vendor can change from time to time, more or less at will. Of course, participants can only change vendors once per year, between November 15 and December 31.
When we sat down to select an insurance vendor for my mother, we made sure that the pharmacy used by her nursing facility -- call it "Drugstar" -- was on the vendor's approved pharmacies list.
Now, here we are, seven months later, and I receive a letter from Mom's insurance company -- call it "BigNameInsurer" that they are dropping "Drugstar" from their list of approved pharmacies, effective January 1, 2007.
Initial inquiries of the nursing home indicate this came as a big surprise to them. In fact, my inquiry is the first they knew of it. They are pursuing it with Drugstar. I suppose they may decide to switch pharmacies if enough of their clients are covered by BigNameInsurer. Otherwise, Mom will have to switch insurance companies. Those are the facts.
Now, I move on to the suppositions. It is reasonable to suppose that some pharmacies, such as Drugstar, attempt to cultivate the nursing care business. In fact, I happen to know that Drugstar serves several nursing care facilities in the northern New Jersey area, and it may serve many others. After all, once on contract with a nursing care facility, you have a pretty stable, continuing source of business, no problems with bad debts, and an easy and predictable delivery schedule. You also have a customer base of very sick patients who are going to need lots and lots of meds. What could be better for a pharmacy?
Enter the Rethuglican's Medicare Part D Prescription Drug plan. As I said earlier, each insurance vendor was given the right to pick and choose among pharmacies it would support. Now, as an insurer, you certainly don't want a pharmacy on your approved list that happens to have an unusually sick group of customers. So, which pharmacies are you going to drop from your list once you have a few months' experience with claims. Of course, you're going to drop the ones who have the largest claims, and those are likely to be the ones like Drugstar having nursing care facilities as a large part of their customer base.
I have a feeling we're just beginning to see the tip of the iceberg here. My guess is that all the vendors are going to start cutting off the pharmacies that do business with hospitals and nursing care facilities, and that ultimately there will either be no pharmacies willing to sell to hospitals and nursing homes or no vendors willing to insure through them.
Three cheers for the Rethuglicans. I guess they knew something the rest of us didn't know when they said the plan would be cheap. They knew that the plan would fail to insure the sickest amongst us -- i.e., those who need it most.
Heck of a job, Brownie.
Here in New Jersey, regulations require all drugs dispersed through nursing care facilities, such as hospitals, nursing homes, and other similar institutions, to be purchased by the facility itself. We learned this when my mother first moved into a nursing care facility here. At first, when she needed prescription drugs, we took the prescription to our own pharmacy and purchased the drugs there, and, for awhile, she was able to take her own medications. However, her Altzheimer's soon progressed to the point where she was missing her meds, or worse still, over medicating. It was at that point that the home advised us that if we wanted their nurses to distribute meds to Mom, they had to be purchased by the home through the pharmacy with which the home had contracted.
I assume the State regulations requiring this are intended to minimize dosing mistakes, and they probably make sense. Indeed, they may not be unique to New Jersey.
In any event, because of that, we are "locked in" to buying drugs through the pharmacy chosen by the nursing care facility.
Along comes Medicare Part D. As you may recall, each insurance vendor participating in the program has its own list of accepted pharmacies, which the vendor can change from time to time, more or less at will. Of course, participants can only change vendors once per year, between November 15 and December 31.
When we sat down to select an insurance vendor for my mother, we made sure that the pharmacy used by her nursing facility -- call it "Drugstar" -- was on the vendor's approved pharmacies list.
Now, here we are, seven months later, and I receive a letter from Mom's insurance company -- call it "BigNameInsurer" that they are dropping "Drugstar" from their list of approved pharmacies, effective January 1, 2007.
Initial inquiries of the nursing home indicate this came as a big surprise to them. In fact, my inquiry is the first they knew of it. They are pursuing it with Drugstar. I suppose they may decide to switch pharmacies if enough of their clients are covered by BigNameInsurer. Otherwise, Mom will have to switch insurance companies. Those are the facts.
Now, I move on to the suppositions. It is reasonable to suppose that some pharmacies, such as Drugstar, attempt to cultivate the nursing care business. In fact, I happen to know that Drugstar serves several nursing care facilities in the northern New Jersey area, and it may serve many others. After all, once on contract with a nursing care facility, you have a pretty stable, continuing source of business, no problems with bad debts, and an easy and predictable delivery schedule. You also have a customer base of very sick patients who are going to need lots and lots of meds. What could be better for a pharmacy?
Enter the Rethuglican's Medicare Part D Prescription Drug plan. As I said earlier, each insurance vendor was given the right to pick and choose among pharmacies it would support. Now, as an insurer, you certainly don't want a pharmacy on your approved list that happens to have an unusually sick group of customers. So, which pharmacies are you going to drop from your list once you have a few months' experience with claims. Of course, you're going to drop the ones who have the largest claims, and those are likely to be the ones like Drugstar having nursing care facilities as a large part of their customer base.
I have a feeling we're just beginning to see the tip of the iceberg here. My guess is that all the vendors are going to start cutting off the pharmacies that do business with hospitals and nursing care facilities, and that ultimately there will either be no pharmacies willing to sell to hospitals and nursing homes or no vendors willing to insure through them.
Three cheers for the Rethuglicans. I guess they knew something the rest of us didn't know when they said the plan would be cheap. They knew that the plan would fail to insure the sickest amongst us -- i.e., those who need it most.
Heck of a job, Brownie.
posted by walldon | 8:23 AM
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