Guest Commentary: THE MEDICARE DRUG DISCOUNT CARD ? A BETRAYAL OF THE ELDERLY?

Medicare outpatient prescription drug coverage is avalid concept and an excellent benefit for thosewho need it. But the program that has been initiated,with the Medicare Drug Discount Card, is seriously flawed.

The state of Pennsylvania has a prescription drug benefitprogram for low-income elderly that is known by theacronym PACE (Pharmaceutical Assistance Contract for theElderly). It is one of a relatively small number of third-partyprescription programs that are highly regarded by patients,as well as pharmacists and physicians.

In February, the Pennsylvania Senate Committee on Agingand Youth convened a group of individuals to discuss howthe PACE program could be integrated most effectively andsimply with the forthcoming Medicare outpatient prescriptiondrug benefit program, and how the PACE program coulddevelop a Medicare drug discount card program that woulduse federal funds for the benefit of both patients and the state.

Concerned about the complexity and many of the specificprovisions of the Medicare drug discount card program,I noted my concern that there would be "chaos" in Maywhen these programs would be marketed by many programsand organizations, many of whom are directly competingwith each other. I wish that my observation wouldhave been wrong, but, now that May has come and gone,"chaos" must be considered an understatement.

There were some provisions of the Medicare drug discount card program that I did not fully understand. Therewere 2 provisions, however, that I thought I clearly understood— the first being that Medicare beneficiaries would beable to make a choice from at least several programs and, second, that an individual could participate in only 1 program(ie, have 1 discount card). I was wrong, as I learned from the very frustrating experience of trying to help my 90-year-old mother translate the communications she received.

My mother is a participant in the PACE prescription program, and shereceived a letter saying that she would be enrolled in the Medicare drug discountcard program offered on behalf of PACE, unless she chose to decline it.This appeared to be a very logical and simple step. My mother, however, hasmedical coverage (ie, physicians, hospitalization), but not prescription coverage(because she has that with PACE) in a Medicare managed care planoffered by Blue Cross. She received a letter from Blue Cross informing herthat she would be enrolled in its Medicare drug discount card programunless she chose to decline it. So at this point, my mother had been informedthat she is being automatically enrolled in not just 1 but 2 programs.

The course of action still seemed clear—she would decline participationin the Blue Cross discount card program and be enrolled in the PACE discountcard program. Yet, the letter from Blue Cross included a statementthat, if the individual did not participate in its discount card program, heor she was not eligible to enroll in any other discount card program. I was certainthat this could not be accurate because my mother is not a participantin a Blue Cross prescription program, and such a requirement would removeany option for choice among the available programs, which I understood tobe an important component of the Medicare legislation.

My attempts to obtain clarification from the Blue Cross Member ServicesDepartment were an exercise in futility. After reaching a supervisor, I was toldthat the personnel had not been provided direction with respect to my questionsand that I would need to call back.

When I called back, I had to persist to speak to the same supervisor, and,once I did, I learned that there were still no answers but that she would callme back soon. I provided my phone number and asked for the phone numberat which I could reach her directly. She refused to provide it. She did callback a short time later, not with answers, but with a response that a lettershould arrive soon that would have the information I requested.

Several days later, my mother received a letter from PACE that essentiallysaid that the insurance company managed care program discount cardtakes precedence over PACE's discount card. In other words, she does not havea choice between programs, but rather her only choice is whether to accept ordecline the Blue Cross discount card. She is continuing in the PACE prescriptionprogram and, therefore, has declined the Blue Cross card. The endresult of all this is no choice and no discount card! I continue to persist in tryingto obtain answers and resolutions.

The Medicare drug discount card program was poorly designed, and thechaos in implementing it was predictable. The elderly have beenbetrayed! The profession of pharmacy was able to have very little influenceon the Medicare prescription drug legislation, and matters could go frombad to worse between now and when the prescription drug benefit is fullyimplemented in 2006.

Our profession should establish our own PBM that would provide a superiorprescription drug and services benefit program. I believe that such a programcould be created that would be financially competitive with existing programs.

What we need now from within our profession are strong leadership, thewillingness of our organizations to work in a unified manner, and moreactive support and involvement from within the profession, particularlypharmacists in community and long-term care practice settings.

We are fortunate in that a comprehensive prescription and pharmacyservices program that will best serve elderly patients also will serve our professionwell. The elderly and their organizations can be a powerful ally forpharmacy. The goals are formidable, but I believe that they are attainable.

Dr. Hussar is Remington Professor of Pharmacy at the Philadelphia College of Pharmacy, University of the Sciences in Philadelphia.