The Medicare Drug Benefit is Coming! Let’s Get Ready!

Circle November 15th on your calendar – that’s the first day when people with Medicare can sign up for the new Medicare drug benefit. And if you sign up this Fall, the benefit will be available on January 1st to help with the cost of prescription drugs.

The Medicare drug benefit will be provided by health insurance companies that are approved by Medicare. AAKP expects many health insurance companies will participate, and each company will likely offer several “prescription drug plans” (PDPs) geared to people with different needs. You should expect to have many PDP choices to sort through – and depending on where you live – perhaps even several dozen or more!

Having many PDP choices may sound challenging – so AAKP encourages everyone to relax and take a deep breath! You may read in the newspapers and hear on TV and radio that some people with Medicare find the Medicare drug benefit plan choices confusing. WE SAY – SO WHAT? With a little patience, by reading about each plan choice (and checking out information on the web if you have Internet access), talking to your doctor about the drugs you take, and comparing notes with other kidney patients, you can become informed and decide which plan best suits you.

Companies offering PDPs start “marketing” on October 1st – providing brochures and other written material. On October 13th, Medicare will post information about each plan at www.medicare.gov – with the actual prices of each drug so you can “comparison shop” among plans.

In choosing a PDP, most kidney patients will look at two features – drug coverage and cost. Each plan will have a formulary, an approved list of prescription drugs available to plan members. Although plans do not have to cover every drug, plans do have to cover all types of drugs. And formularies can have tiers where the co-pays vary – for example generic drugs may have smaller co-pay than brand name drugs. (One exception is all immunosuppressive drugs will be covered.)

PDPs may also vary by other costs – for example, the deductible (or amount that must be spent on drugs before the plan covers any drug costs) and monthly premiums.

Most kidney patients will be looking for the best combination of formulary coverage (the drugs you need) and cost. (Note: Medicare will also provide extra financial help to many people to cover these costs – see the “To Do” list below.)

Many kidney organizations will post general advice and information on their Web sites about the new drug benefit – AAKP included, of course (www.aakp.org)!

There is also a Web site about the Medicare drug benefit designed especially for people with kidney disease (www.kidneydrugscoverage.org), which is a joint project of 35 kidney organizations, including AAKP.

Here’s something else to think about. If you are on Medicare now, the last day to sign up for the Medicare drug benefit without financial penalty is May 15. If you join after that, you will be charged an extra fee every month thereafter. The reason is to discourage people from signing up only after they need the benefit. However, the advantages for most kidney patients will be so great that signing up right away is likely your best option.

Let’s put all these suggestions together in a short “To Do” list:

1.    Make a list of all prescription drugs you take and their cost today. Your doctor and pharmacist may be able to help you put together this list.

2.    Find out which Medicare PDPs are available where you live. In October, Medicare sends out its booklet, Medicare & You 2006, which lists all plans where you live. You can also visit www.medicare.gov or call 1-800-MEDICARE to get information about plans in your area after October 1st.

3.    Do you have any prescription drug coverage now? You may want to compare your current drug coverage with new Medicare PDP choices – to decide whether to switch or not. People who receive drugs under Medicaid will be automatically be enrolled in the new Medicare drug program.

4.    Also, check which pharmacies are in the plan's network. If you plan to travel, be sure a plan will cover pharmacies away from home.

5.    How to compare PDP choices? First, check your lists of drugs against the drugs in each plan’s formulary – and figure out how much your drugs will cost under each plan. Then, on a piece of paper, list on each line the name of a plan – together with important features like how well your drugs are covered and other costs for deductible and co-pay. Soon a few plans should stand out as best choices.

6.    Have you checked whether you are eligible for extra financial assistance? In the July issue of aakpRenalife, AAKP encouraged all kidney patients to check if they are eligible for extra financial assistance with the new drug benefit.

7.    Thinking about not signing up for Medicare prescription drug coverage? You could lose out on a great benefit – and it will be more costly to sign up later.

The Medicare drug benefit is the biggest change in Medicare in 40 years. For kidney patients, it promises to be a very good deal. Good luck!

This article originally appeared in the November 2005 issue of aakpRENALIFE, Vol. 21, No. 3.

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