Dr. Smith in New Mexico, for example, estimates that it takes 40 minutes per patient to obtain each authorization.
Also, everyone interviewed here wonders about the potentially biggest frustration of all: Will all the prior authorizations have to be resubmitted each new year when coverage begins anew or every time a patient changes a plan? Will the authorization ever follow the patient and not the plan?
Prior authorization, staff costs, and the frustrations of dealing with new regulations are only the beginning of the challenges presented by Medicare Part D. From the patient’s point of view, selecting the most individually beneficial plan, changing medications to meet coverage requirements, and working with the physician to create the best treatment regimen under given circumstances can be demanding tasks.
Then there is the high cost of coverage during the doughnut hole. For example, Lois, an RA patient in Chicago, takes Humira. She is happy that Part D is sparing her from paying her total drug costs. Nevertheless, because of the expense of her medication, she is concerned about the doughnut hole.
These patient problems are also the rheumatologist’s problems. “We have to accommodate the regulation because our patients can’t afford to do otherwise,” says Dr. Denio.
Provides Needed Coverage
Without exception, the physicians interviewed agree that Medicare Part D, for all its flaws, provides coverage that otherwise would not be available. Dr. Denio calls it a “bargain compared to going without.” Dr. Morris sees it as a real bonus for those in his district who have never had medication coverage, and Dr. Fohrman thinks it provides a service for those who cannot afford medication at all.
On the other hand, “It can be problematic,” says Dr. Fohrman. Still, as Medicare Part D continues to be tweaked, and as clinicians and patients voice their concerns and demand changes, there are likely to be improvements. Many rheumatologists working with the plan now have ideas and, in the end, Medicare Part D may become a workable plan for the ever-aging population in the United States. (See “Meeting the Challenges of Part D,” page 23.)
Ann Kepler is a medical journalist based in Chicago.
