There are so many choices and different features that it can be intimidating. And this choice must
be made by ANY senior who is eligible for Medicare (less those with “creditable” drug coverage plans,
such as those who have union pension benefits). This includes seniors with Medicaid coverage; specific
provisions exist to force Medicaid patients into a Medicare Part D plan that will be the first payor toward
prescription drugs. If Medicaid patients do not choose a Medicare Part D plan on their own, the state
they live in will choose one for them! This plan may not be the best choice for this patient, so it is important
to consider all plans available for that person to find the best fit.
So, how to choose? First, consider the medications that a person is taking, the chronic conditions being
treated, the seniors general health, and the senior persons lifestyle. If a senior is generally healthy, not taking
many medications, then a low-cost plan such as the Humana Walmart plan might be ideal. This plan
is built to have a very low monthly payment (the monthly “premium”). Seniors that choose this plan will have low
cost, but might consider the inconvenience of having Walmart services (limited hours, very busy stores with sometimes
impaired access to the pharmacist, loooong walk through that oversize parking lot, few drive through options).
This may not be a factor for a senior that doesn’t use the pharmacy much, and doesn’t expect to in the next year.
For seniors that are taking many more medications,however, or have certain chronic conditions like asthma or diabetes, it might be
more beneficial to choose a pharmacy chain such as CVS or Walgreens. This would probably negate the benefits of the Medicare
Part D plan above. In our opinion, patients with chronic conditions might prefer better access (ie 24 hours stores conveniently located, plentiful drive through options for patients, pharmacy staff with a shorter distance into the store, etc). Woe unto the Walmart patient that needs an inhaler to open their lungs at 3am on a Sunday morning! Diabetic Walmart patients may face the same fate when dropping
and breaking their last vial of insulin on a holiday.
For seniors that want better access, there are many plan choices, such as those offered through AARP. Chains such as CVS
and Walgreens accept most major Medicare Part D plans, and the copays are generally the same wherever you go. There
are some exceptions, however. There has been much press about the company Express Scripts and its ongoing dispute with
Walgreens. As of this writing, there is no agreement between those companies. We recommend that seniors that wish to use
Walgreens pharmacies steer clear of Express Script plans (which may not be branded so). If you wish to use Walgreens,
make extra certain that the plan chosen is not an Express Script (ESI) plan!
The last consideration would be tougher for seniors and caregivers, but is no less important, is the “donut-hole.” While legislation
is set to slowly phase out this monster, it still will affect seniors that take a lot of high cost medications. So, how does it work?
We will discuss that in our next post!