Transplant patients urged to set up account for drugs

June 19, 2006

Making sense of Medicare Part D prescription drug plans has been a major challenge for seniors. But for Medicare Part D recipients who have received organ transplants, choosing a plan is the least of their problems.

Making sense of Medicare Part D prescription drug plans has been a major challenge for seniors. But for Medicare Part D recipients who have received organ transplants, choosing a plan is the least of their problems.

The way that Part D is structured, health systems, in some cases, have been forced to require transplant patients to cough up hundreds-in some cases, thousands-of dollars in out-of-pocket expenses up front for their posttransplant, life-sustaining immunosuppressive drugs.

Shands HealthCare in Florida, for one, asks transplant patients who are Part D beneficiaries to establish a $3,000 to $5,000 pharmacy account in order to pay for posttransplant medications. That practice has sparked criticism from watchdog groups and others that have been lobbying public officials in Tallahassee on behalf of patients.

But despite the criticism, Shands defends its practice, asserting that, in the absence of comprehensive Medicare Part D coverage, having patients establish a pharmacy account helps to ensure that they will receive their necessary drugs.

Bill Harbilas, Pharm.D., clinical specialist in ambulatory services at Shands, said that the pharmacy account is not money that patients lose-if they don't use it all for medications, they get it back. "These are patients with either public or private insurance who have holes or weaknesses in their coverage that we think will put them at risk after their transplant," he said. Most patients come up with the money, he noted, and for patients who have extenuating circumstances, the policy is not set in stone. "There are special circumstances under which we relax the requirements when necessary."

The pharmacy accounts require just enough money to ensure patients get medications through their first and most crucial posttransplant year, and the money is returnable if not used.

When low-income patients need to use the money in their accounts to buy medication, Shands gives patients the option to purchase drugs at the hospital's outpatient pharmacy, where they are charged only what the hospital pays to dispense the medication. "We don't make any money on them," said Harbilas. He pointed out that he meets with and counsels patients on how important it is for them to take their posttransplant medications.

Transplant patients can get their immunosuppressant drugs under either Medicare Part B or Part D. Part B will pay 80% of the cost of immunosuppressant drugs if the patient is covered by Medicare Part A at the time of transplant. However, the remaining 20% cannot be covered under the new Part D. This 20% co-pay can easily be more than $200 per month.

On the other hand, if a transplant patient is on private insurance, then turns 65 and gets Medicare Part D, his immunosuppressant drugs will be covered under Medicare Part D. Medicare Part B will not be involved.

Despite the unpopularity of the pharmacy accounts, Harbilas asserted that the process works for patients. "We want the patients to partner with us, which helps them in the long run." He said that when patients are involved in setting up their own drug accounts, they make better patients and the outcomes are much better.