Medicare-Approved Drug Discount Cards Now HereThe federal government unleashed 28 different discount cards on the Medicare population on May 3, and by now those persons are flooding your pharmacy expecting you to know exactly what is going on. Pharmacists attending the OPA Annual Conference on Sunday, April 18, heard several excellent speakers clarifying as much of the program as possible. However, Greg Chesmore, from CMS, (Centers for Medicare & Medicaid Services), made it clear that the federal government would not allow the companies providing the 28 cards in Ohio to distribute marketing information until May 3. Therefore, as this journal goes to print, OPA does not have marketing information to share with you. In order to receive the latest information on the Medicare cards, please be sure that OPA has your current e-mail address. We will be updating OPA members with information as it is received. If OPA does not have your email address, please use the following link, $$Link,AWS_SSL:DisplayInputForm&FormID=40,Email Update Form$$, to send us your current e-mail address.
What Cards are Approved for Ohio?
The following companies are among those that will be marketing cards in Ohio. Some of the companies, such as MemberHealth, will have more than one card. The Golden Buckeye card, for instance, has been approved as a Medicare discount card which will cost money to purchase, but the regular Golden Buckeye card will remain available for free. Here is the list of approved companies:
Aetna Health Management, LLC; Caremark Advantage, Inc.; Catalyst Rx; Medco Health Solutions, Inc.; PBM Plus, Inc.; PharmaCare Management Services, Inc.; Pharmacy Care Alliance, Inc.; Scrip Solutions, LLC; SXC Health Solutions, Inc.; United Healthcare Insurance Co.; WellPoint Pharmacy Management; Express Scripts, Inc.; Argus Health Systems, Inc.; Computer Sciences Corp.; WHP Health Initiatives, Inc.; AdvancePCS Health, L.P.; First Health Services Corp.; Community Insurance Company (2 plans); Health Plan of the Upper Ohio Valley; Hometown Health Plan; SummaCare Inc.; United Healthcare of Ohio, Inc.
How Will Patients Sign Up for Programs?
There will be millions of dollars spent to market all these cards to patients. There will be a few cards that national pharmacy organizations will be marketing in cooperation with pharmacies. OPA is partnering to market the NCPA (National Community Pharmacists Association) product, the Community Care Rx Program. That program is similar to Golden Buckeye, in that the pharmacy will receive 5% of any rebate as part of the reimbursement process, which seems to be unique among the cards. Pharmacies will receive marketing materials from Community Care Rx on May 3. Other programs being marketed with pharmacies include the NACDS (National Association of Chain Drug Stores) endorsed card, the Pharmacy Care Alliance card. PBM Plus, Inc., an Omnicare Company, is another Ohio-based company planning to work with pharmacies.
Will There be Payment to Pharmacies for Enrolling Patients?
In a word, “no.” The Inspector General of the United States issued an advisory on April 8 that such payments would be construed as a kickback, and will not be allowed.
How Can I Find Out More About Prices, Etc.?
Medicare has placed an amazing amount of information on the web that you will find extremely useful and interesting. Individuals will be able to not only find out the price of the drug, but what your exact reimbursement is on a particular drug. This is especially interesting since the reimbursement rates were supposedly “negotiated” with each pharmacy, even though the price the PBMs and others “dictated” to you are published on the web. Just go to www.medicare.gov, and select Prescription Drug and Other Assistance Programs. Greg Chesmore of CMS said that pharmacists may want to pretend to be a Medicare patient, and put in any drug for which you want to see relevant information. He indicated that it is valuable for pharmacists to do this, so that you can give OPA input on any problems you encounter. This information can then be passed on to CMS by Ernest Boyd during regularly scheduled conference calls regarding the program.
Here are some of the things that you and patients can do when searching the web. First, of course, they can find the current price of the particular medication, updated weekly. Second, the site will list the prices charged for various dosages of specific drugs at retail pharmacies in or near a given ZIP code. If a brand-name drug has generic equivalents, those prices will also be shown. In addition, the website will list prices for competing brand-name drugs used to treat the same condition. Thus, a person shopping for Lipitor could see the prices for other cholesterol-lowering agents, like Zocor and Crestor. This will give pharmacists a great opportunity to give patients prices of generic drugs in the same category that physicians can be encouraged to prescribe. The web site will provide access to prices for more than 60,000 products sold at nearly 75,000 pharmacies around the country.
How Can the Elderly Access Info without the Web?
Tell them to call a toll-free telephone number, 1.800.MEDICARE (1.800.633.4227), to obtain prices for the medicines they use. They can talk to someone who supposedly will go through the work of finding a low priced drug. Or, you can set up a computer in your pharmacy to assist the patient. DestinationRx, a small company based in Los Angeles, developed the software needed for comparison shopping and will tabulate the prices reported by drug card sponsors.
Where Can Pharmacists Go for More Information about Drug Card Contracts?
OPA’s Independent Special Interest Group (SIG) members have access to PAAS National’s website, where a complete list of the programs, contact numbers, reimbursement rates, details, deadlines, and addenda are available. You can contact PAAS about joining by calling 888.870.7227 or accessing their website at www.paasnational.com. NCPA members can find a similar list at NCPA’s Contract Clearinghouse. The Pharmacy Care Alliance has an excellent free newsletter that you can order at http://www.smartbrief.com/pca/. You can learn about the Community Care Rx card (endorsed by NCPA and OPA) at www.ncpanet.org, and click on the Community Care Rx link. Again, the general Medicare information on the cards is available at www.medicare.gov. Marketing information may soon be available through www.cms.hhs.gov. Another online source of the Kaiser Family Foundation is www.kff.org/medicare/factsheets.cfm.
OPA will continue to keep you informed as this program unfolds.
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February 28, 2016
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