New e-tool helps R.Ph.s advise dual eligibles on Medicare

July 11, 2005

An electronic tool is being developed to help pharmacists assist seniors on Medicaid who may be confused about having to choose a Medicare prescription drug plan by year's end.

An electronic tool is being developed to help pharmacists assist seniors on Medicaid who may be confused about having to choose a Medicare prescription drug plan by year's end.

By this fall, the Centers for Medicare & Medicaid Services will randomly assign seniors eligible for both Medicare and Medicaid to a drug plan covering their area. However, these so-called dual eligibles will be able to switch plans after the Part D benefit goes live on Jan. 1. They may be facing a lot of choices without knowing whether their medications are covered or if their pharmacy is in the plan. That scenario is an invitation to mass confusion that means many seniors will be heading to their local pharmacy for help.

With the aim of doing a good deed for both the dual eligibles and their pharmacists, Informed Decisions has come up with a way for seniors and pharmacists to compare Medicare drug plans, the drugs they cover, and the pharmacies that take the contracts, said president David Medvedeff, R.Ph. His firm is a subsidiary of Gold Standard, a Tampa, Fla.-based drug information database, software, and clinical information solutions firm.

Phase two of the plan is to make the same information about drug plans and covered drugs available electronically to retail pharmacies at no cost. The company is working closely with members of the National Association of Chain Drug Stores and the National Community Pharmacists Association to work out the details, raise funds, and spread the word.

Even without publicity about the plan, seven state Medicaid programs and one state drug assistance program have made a commitment to Informed Decisions.

Informed Decisions plans to mail letters written on state letterhead to dual eligibles after CMS has published the drug plan formularies, probably in October, said Medvedeff. "The database is being built now, and we'll demonstrate it in early August," he said. "We don't plan to pull the beneficiaries' 90-day drug data until the last minute so they'll be more current."

The states that are on board represent 1.5 million out of the 6.4 million dual eligibles, who will be the "canary in the coal mine" for the larger Medicare Rx drug program, said Medvedeff. "If they have a bad experience, it will discourage other beneficiaries from signing up," he said. "And auto-assignment of dual eligibles to Medicare is an archaic method that could hurt patient care because the pharmacy they've used for years might not be in the network and their medications might not be covered by the plan."

Convinced that the service will help R.Ph.s more efficiently answer beneficiary questions, NACDS is trying to get financial support to underwrite the operation, said general counsel Don Bell. The letters and electronic database will be free to states, beneficiaries, and pharmacies. "We know pharmacists are the most trusted sources for information, and we know from the discount card program that patients don't often go to a Web site for information and they can be easily confused by written materials," he said. "They end up going to the pharmacist and asking what to do. This is a way of giving pharmacists information they need to answer those questions."