Medicare Steps Up Efforts To Monitor Seniors'
Prescriptions
Insurance company representatives - in most cases,
pharmacists - must ask heavy drug users in Medicare about their
medications and side effects.
By Susan Jaffe, Kaiser Health News
March 23, 2010 - Irene Mooney survived four heart
attacks and still copes with high cholesterol, persistent indigestion
and heart problems. Recently, she developed some dangerous new symptoms
— suspicious bruising all over her body and severe fatigue. “I could
barely put one foot in front of the other,” she says. A pharmacist
discovered the culprit: Some of the very medications Mooney was taking
to manage her medical conditions.
The pharmacist met with Mooney, examined her 13
medications and then contacted her doctor, who cut the dosage of one
drug and replaced another, reducing her risk of uncontrollable bleeding.
Mooney, 82, one of the devoted card players at her seniors’ complex,
soon noticed the change. “I’ve been so much better,” she says.
The help Mooney got — called “medication therapy
management” — was provided by Senior PharmAssist, a Durham, N.C.,
non-profit group that makes sure seniors use the right prescription
drugs and take them correctly to prevent harmful side effects or drug
interactions.
Medicare Rights Center says seniors should know
Medicare private health plan will not work with a supplemental ‘Medigap’
plan as with Original Medicare
Now, medication management is coming to nearly 7
million seniors and disabled Americans enrolled in Medicare drug plans.
Under new, tougher Medicare rules that took effect in January, private
insurers that offer drug coverage must automatically enroll members who
have at least $3,000 in total annual drug costs, take several drugs and
have chronic health conditions such as diabetes, hypertension or heart
disease.
Insurance company representatives — in most cases,
pharmacists — are required to ask these members about their medications
and side effects. They must report any problems to patients’ doctors,
along with recommended changes such as lowering the dose or replacing or
eliminating a drug. Patients can drop out of medication management at
any time.
●
57% of seniors forget to take
medications
● 23%
neglected to fill a prescription on
time
● 40%
of seniors (taking 5 or more drugs regularly) are worried about their ability to afford their
medications
● 49%
of those enrolled in Medicare Part D would
like to know how to delay or avoid entering the Medicare Coverage Gap
(the “Donut Hole”)
The goal is to keep seniors healthy by detecting
medication-related problems. That would be welcomed by most doctors,
says Peter DeGolia, director of geriatric medicine at University
Hospitals Case Medical Center in Cleveland.
Yet he’s concerned that health plans might pressure members to take
cheaper or fewer drugs. If that happens, he says, doctors won’t comply.
“Sometimes it’s beneficial for the insurance plans, but not the
patients,” he says.
R. Sean Morrison, a professor of geriatrics and
palliative medicine at Mt. Sinai School of Medicine in New York City,
warns that medication management could backfire because pharmacists
working for the insurers don’t know the patients’ medical history.
“These are often not simple and straightforward decisions,” he says.
This story was produced in collaboration with
Strengthening The Rules
Insurers say they can play an important role in the
doctor-patient relationship.
Catherine Misquitta, pharmacy director for Health
Net, which provides drug coverage to more than 687,000 seniors, cites
“numerous cases” in which neither the member nor the physician realized
— until Health Net told them — that the patient had two very similar
drugs for the same condition prescribed by different physicians, usually
a primary care doctor and a specialist.
Ed Pezalla, the chief of Aetna’s pharmacy division,
which has more than 586,000 drug plan members, says even when a
pharmacist suggests a less costly drug, “the final decision always rests
with the patient and the prescribing physician.”
Nearly 28 million older and disabled people get
Medicare-subsidized drug coverage from insurance companies. Almost a
quarter of them will be eligible for medication management under the new
rules — about twice as many as last year, Medicare spokesman Peter
Ashkenaz says. When Medicare drug coverage took effect in 2006, Congress
required health plans to provide medication management, but the rules
were so vague that an insurer could comply simply by sending a brochure
to someone with diabetes.
Under the tougher rules, that won’t be enough. The
service must include an annual medication review and quarterly
reassessments. Discussions must be in person, over the phone or via the
Internet, and seniors must get a written summary.
William Fleming, Humana’s vice president of
pharmacy and clinical integration, says a patient who takes the correct
drugs — whether they’re brand-name or cheap generic versions — may stay
healthier and file fewer medical claims.
People over 65 take twice as many medications as younger adults, an
average of six to seven drugs for multiple chronic health problems,
according to a study by the federal Agency for Healthcare Research and
Quality. Seniors often get prescriptions from multiple doctors and fill
them at different pharmacies. Aging bodies process medications less
efficiently, so normal doses can build to dangerous levels. Seniors who
can’t afford their medications may skip doses or cut pills in half.
Any one of these situations could cause serious
problems, says pharmacist Gina Upchurch, founder of Senior Pharm8Assist.
Meetings Not Required
Upchurch worries that Medicare’s medication
management won’t detect such problems because the new rules don’t
mandate face-to-face meetings with patients.
“I can’t teach you to use an inhaler without seeing
you,” Upchurch says. “I can’t see if you are drawing up your insulin
correctly over the phone.”
Ashkenaz says officials were reluctant to impose
such a requirement because some older people may have trouble getting to
those meetings. The agency will consider changes as they evaluate
reports from insurers.
Geneva Boykin, 79, went to Senior PharmAssist last
year after complaining of stomach pain. A pharmacist reviewed her 14
medications and contacted Boykin’s doctor, who stopped one drug and
reduced the dosage of another. Six months later, in January, Boykin
returned with good news. “I don’t have the burning in my stomach,” she
said.
March 23, 2010 - Irene Mooney survived four heart
attacks and still copes with high cholesterol, persistent indigestion
and heart problems. Recently, she developed some dangerous new symptoms
— suspicious bruising all over her body and severe fatigue. “I could
barely put one foot in front of the other,” she says. A pharmacist
discovered the culprit: Some of the very medications Mooney was taking
to manage her medical conditions.
