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Medicare wants pharmacists out of Plan D decision-making process

Updated: September 24, 2012 6:25AM



Walgreens pharmacists are no longer giving customers advice on which Medicare Part D plans best work with the customers’ prescriptions by the Dec. 31 deadline, and a Medicare spokesman says that’s a good thing.

People should get help with their Part D plan choice by calling the Medicare help line at 1-800-MEDICARE (1-800-633-4227) or by getting counseling from AARP or their local State Health Insurance Assistance Program (SHIP), according to Medicare, because pharmacies get rewarded for putting or keeping customers in plans or prescriptions administered by so-called Pharmacy Benefit Managers, or PBMs.

PBMs such as Medco, Caremark and Express Scripts set up lists, called formularies, of drugs for which the PBM has negotiated a deal from which the PBM profits.

“If the pharmacy is benefiting from a certain PBM’s plan because it provides a richer reimbursement (to the pharmacy), the pharmacists shouldn’t jade the conversation about Medicare options based on how they are reimbursed,” said Medicare spokesman Tony Salters. “I’m not saying it is being done, but it could be done.”

Walgreen Co. spokesman Robert Elfinger said the Medicare Part D plan-comparison report was removed from Walgreens website and retail pharmacy system due to “programming issues.”

But Walgreens pharmacists stopped using the system after Humana filed a lawsuit against Walgreens, alleging that Walgreens’ online “plan finder” tool was displaying inaccurate information about Humana Medicare prescription-drug plans and was listing prices for Humana plans that were higher than the actual prices.

Soon after Humana’s Dec. 3 court filing, Walgreens chose to remove the plan-finder tool from its website, said Humana spokesman Jim Turner.

Walgreens declined to comment except to say that Humana voluntarily withdrew the lawsuit. Walgreens had issued a press release on Nov. 15 saying that “Walgreens pharmacists will be one of the best resources for Medicare Part D information, offering a free comparison report.”

CVS pharmacists continue to provide advice, with company spokesman Mike DeAngelis saying that if the pharmacist is too busy or the Medicare website inaccessible when a patient wants to talk, the pharmacist will go out of his way to get the information to the customer, either by setting up another meeting or, if requested, mailing to the customer the comparison report. The report shows plan-costs based on the medications that a person is taking.

Mike Patton, executive director of the Illinois Pharmacists Association, said Tuesday that with the role PBMs play, pharmacists should not recommend Plan D options.

Medicare recommends that people use these resources instead of their pharmacies to find the best Plan D option for them:

** Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

** Review prescription drug plans at www.cms.hhs.gov/center/openenrollment.asp

** Medicare beneficiaries who cannot afford the price of prescriptions may be eligible for a program called Extra Help. The beneficiaries or their family members, trusted counselors or caregivers may apply online for this help at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778).



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