Seniors negotiate Medicare drug plans | AspenTimes.com

Seniors negotiate Medicare drug plans

John Colson

Rodney Diffendaffer, owner of Rodney's Clinic Pharmacy on West Main Street, helps Betty Pfister with prescription questions. (Mark Fox/The Aspen Times)

Aspen-area senior citizens appear to be figuring out the complex Medicare Prescription Drug Benefit program.In the Aspen area, the Prescription Drug Plan options may be somewhat narrower than in other locales for seniors hoping their prescription drugs will become more affordable.Local pharmacies in the upper Roaring Fork Valley say they will be working with a relatively small number of drug insurance company plans, while large chain pharmacies downvalley (including City Market, Kmart, RiteAid, Target, Safeway and Wal-Mart) have contracted with numerous companies, according to the Colorado Division of Insurance.But despite the seeming limitations facing customers of the small, independent pharmacies in Aspen and Snowmass Village, local officials have not had many complaints about the availability of prescription drugs represented by the plans.At Rodney’s Clinic Pharmacy, 100 E. Main St., Pharmacist Rodney Diffendaffer said he will be working with the Humana and Aetna insurance companies, and Rocky Mountain HMO. He was negotiating with PacifiCare, he said, but those negotiations broke down.”They don’t want to pay us any money,” he said defiantly, referring to the “reimbursments” insurance companies pay pharmacies that fill subscriptions for the companies’ customers.At Sundance Drugs in Snowmass Village, head pharmacist Dan Kociela said the only insurance companies contracted with so far are Community Care Rx, a company he identified as Medco and one he called United Health Care. He said Sundance will sign up with other providers at his customers’ request.”A lot of seniors have said it doesn’t matter to them” whether local pharmacies sign up with a broad range of plans, said Natalie Trecker, administrative assistant at the Castle Creek Terrace senior center.She explained that many local seniors travel to downvalley pharmacies for their prescriptions, where greater competition can mean lower costs and possibly greater variety in PDPs. And, according to officials, many Aspen-area seniors receive their prescription drugs through mail-order services, bypassing the need to go to a pharmacy entirely.Trecker said the office has been fielding “a steady stream” of questions about the new program from seniors who, starting Jan. 1, will be eligible for Medicare Part D, the national prescription drug benefits plan President Bush and Congress recently created.The plan is expected to affect some 43 million people currently eligible for Medicare, as well as some 6 million who are enrolled in both Medicare and Medicaid, known as “dual-eligibles” in the health care bureaucracies.Such “dual-eligibles” must sign up for a coverage plan by Dec. 31 or they will automatically be enrolled in a plan of the state’s choosing, according to officials from the Centers for Medicare & Medicaid Services.News stories around the country have reported on seniors’ frustration concerning the complex and sometimes confusing array of insurance company drug plans, of which 44 are available in Colorado, by 17 different insurance companies. Colorado has approximately 500,000 seniors enrolled with Medicare, according to Liz Tredennick of the State Health Insurance Assistance Program.Tredennick said her office has been getting calls since September about the new drug benefits, and that many of those callers have been “confused.”But, she said, “The consumer awareness is definitely increasing,” and callers are now “asking specific questions” that indicate a basic understanding of the new programs.These programs are outlined in a booklet the state put out, titled “Medicare Drug Insurance and You: Colorado Options 2006.” The 16-page booklet, available from county health and human service agencies and other outlets, explains the national Medicare PDP and its implications for Colorado residents.These implications include answers to questions about how the overall program affects those enrolled in Medicare or Medicaid, or both; those with private insurance coverage or who are part of a union or retiree health care plan or the national veterans’ health care plan known as Tricare; and how Medigap coverage might stack up compared to the new PDP.The booklet also lays out the various plans being offered by the insurance companies, complete with a listing of some 200 commonly prescribed medications and the costs of prescriptions to consumers under the different plans.Another page lists the plans companies offer, by name, alongside columns depicting the premiums consumers pay, the annual deductible amounts, the “coverage gap” the insuree pays, any required copayments, a list of participating pharmacy chains and the percentage of the 200 commonly prescribed medications that are covered under particular plans.Those with questions can call their county health and human services offices or senior services offices, which in Pitkin County can be reached at 920-5432.Information also is available at the Medicare Web site, http://www.medicare.gov, and at the toll- free phone number, (800) MEDICARE.The “Medicare Drug Insurance and You” booklet is available, as is more information, at the SHIP office, (303) 894-7533.John Colson’s e-mail address is jcolson@aspentimes.com