When the new Medicare prescription-drug discount cards become effective June 1, healthcare providers-and physicians in particular-are likely to face a barrage of questions from seniors.
The CMS expects some 7.3 million seniors to enroll in the drug discount-card program and is working on an education effort so providers and patients alike know how the cards work, who provides them and what benefits they can bring. Since seniors most often meet face to face with caregivers in a doctor's office, that's where many of the questions and concerns are likely to crop up.
"We just need to keep saying it over and over and reminding patients that they need to get (a card)," said Michael Fleming, a family practice doctor in Shreveport, La., and president of the American Academy of Family Physicians. Fleming said he already gets Medicare-related questions from patients every day.
To help its members, the American Medical Association is sending doctors a "pocket guide" on the drug card and directing them to the Web site, medicare.gov, for information their patients request. "I'm always impressed with how quickly patients find out the rules of the game," said AMA President Donald Palmisano. "HHS is working diligently to get information out," he said. "Here's an opportunity to help with medication costs and make sure everyone who's eligible knows about it."
While doctors are the primary contact for many seniors, hospitals can and should play a role in education too, one CMS official said. "Hospitals have natural networks they can use to engage and talk to patients," said Herb Kuhn, director of the CMS' Center for Medicare Management, which is working alongside the agency's Center for Beneficiary Choices to put the card program in place.
"The extension of the drug benefit to a huge part of the population meets nicely with hospitals' mission statements," Kuhn said.
Unless they have Medicaid drug coverage, all Medicare beneficiaries are eligible for the voluntary discount cards, which will be provided mostly by managed-care companies and pharmacy benefit managers. So far, the CMS has approved 71 companies' general drug-discount cards, including 36 available nationally.
Seniors with a card are likely to receive average discounts of 17% for brand-name drugs and 35% for generic drugs, according to a survey released last week by the Pharmaceutical Care Management Association, or PCMA, which represents pharmacy benefit managers.
Individual seniors with incomes of less than $12,569 per year qualify for a $600 credit on their drug card that can further help absorb prescription costs. Congress has estimated seniors will save 15% to 25% on the cost of their drugs.
The Medicare-approved discount cards "are a defining moment for our industry," Mark Merritt, president of the PCMA, said last week. "The discount card is here and now (and) we envision it being very successful."
Merritt and others, including CMS officials, said they did not know how much of the discounts would be absorbed by manufacturers and how much by retail pharmacies.
Starting as soon as this week, the PCMA will run advertisements on television and in newspapers to raise awareness about the card and encourage seniors to enroll. The AARP and other groups have also promoted the discount cards and sent detailed information to members.
Such efforts will dovetail with the CMS' ongoing Medicare education campaign. Last year's prescription drug law allocated $1 billion over 10 years to the CMS to educate seniors and others about the new benefits.
More than 8% of the nation's social workers work in a hospital or healthcare setting, according to the National Association of Social Workers. Having vocally opposed the Medicare drug law, however, the group is treading cautiously as it decides whether and how to work with the CMS on educating seniors.
"CMS has approached us to help with the education process," said Lahne Mattas-Curry, a spokeswoman for the social workers' association. "However, we haven't accepted the offer yet." A CMS spokesman said the agency is continuing discussions with the association. "Nothing has been put in stone yet, but the relationship is still positive," the spokesman said.
The CMS has also consulted with the American Hospital Association and similar groups to develop industry education strategies.
For the past few weeks, government officials have touted the CMS' soon-to-be-unveiled Web site that enables seniors to compare the prices of specific drugs under each card. "It's important that Medicare beneficiaries have all the information available to make decisions about choosing the card that best fits their needs," CMS Administrator Mark McClellan said last month.
The CMS also announced last week that it created a standard enrollment form that all Medicare drug card programs will accept and will make it easier for seniors to get coverage. In addition, the CMS said it will carefully monitor the card programs to prevent fraud and abuse, including the identification of any programs that stray from expected changes in prices and card sponsors.
In Congress, meanwhile, Sen. Kent Conrad (D-N.D.) introduced a bill that would allow pharmacists to reimport less expensive drugs from Canada and strengthen the Medicare law's requirement that seniors have access to the local pharmacy of their choice.