MMA: A mixed bag for pharmacists

October 10, 2005

As this editorial goes to press, we're hearing the first details about which Medicare prescription drug plans (PDPs) have received approval from CMS.

Let's face it, the Medicare drug benefit might not be a blessing for all seniors. There might be some beneficiaries who, after calculating how much they have to pay for their monthly premiums, deductibles, co-pays, and coinsurance, might be better off not taking part in the program. On the other hand, there are many low-income elderly patients taking multiple drugs who could stand to gain appreciably from it.

The same mixed picture applies to pharmacies. If you think Medicaid reimbursement is low, some Medicare contracts pharmacies have been asked to sign have offered even lower payment rates. Furthermore, many pharmacies are finding themselves not in preferred networks but in the nonpreferred ones that are associated with higher co-pays. To make matters worse, community pharmacists are beginning to realize that many PDPs won't be using them to provide medication therapy management (MTM) services. Instead, they might use their own in-house pharmacists, or a mix of their own staff and community pharmacists, or health professionals who are not even pharmacists to provide MTM.

If worse comes to worst and the Medicare Modernization Act (MMA) hurts, rather than boosts, pharmacies' bottom lines, there are still certain provisions in the act that could be a positive for the profession. Consider the following:

These provisions all have the potential to expand the clinical role of pharmacists.

Speaking for myself, as a consumer, I must say I appreciate having this new benefit available, since my employer doesn't offer any health insurance for its retiring employees. Although I am still years away from being Medicare-eligible, and I am healthy enough that I don't have to take any medications, I'm glad to have this fallback plan to take care of any potential catastrophic drug costs. Certainly the low monthly premiums of $20 a month that some PDPs are charging make the program seem painless. Heck, even my monthly phone bill costs more than that.

But low premiums are logical for the first year, when PDPs want to draw as many enrollees as possible right out of the gate. I just hope that premiums won't soar in subsequent years to such an extent that seniors will rise up in revolt and demand that the program be abolished. That's what happened with the Medicare Catastrophic Coverage Act of 1988.

Having been with Drug Topics for 25 years, I was here to see the rise and fall of that law. I still remember the amount of ink the press devoted to that bill and how it was summarily killed a year after it passed. That law failed because as premiums rose, Medicare beneficiaries felt they were getting a raw deal and they wanted out.

If MMA is still in operation when I reach 65, I plan to do my part and sign up for it. The program needs both healthy and sick seniors to participate. That's what health insurance is all about-it's everyone sharing in the risk.