Pharmacists Prepare for New Medicare Drug Benefit

Medicare's new prescription-drug benefit begins next month. It's not just seniors who are befuddled by all the choices. Many of their baby-boomer offspring are also having trouble figuring out which plan is right for mom or dad.

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And once people do manage to sign on to one of the new Medicare plans — "Part D plans" that take effect Jan. 1, 2006 — the next hurdle is for the government to make sure their information gets into the huge Medicare database so pharmacists can access it when it's time to fill prescriptions.

The pressure is on pharmacies, which will have to incorporate the information into their billing.

And pharmacies are already very busy. At Grubb's Care Pharmacy, in a small house two blocks from Capitol Hill, everyone is in motion. There are no chairs around, and there's a lab in back.

Pharmacist Ed Dillon says there are 33 people on staff. Employees squeeze past each other through narrow aisles. They put tablets into "push packs," compound drugs and load liquid into syringes, while delivery people run in and out.

There's a heavily used computer in the middle of all this, where pharmacists check with insurance companies on their customers' coverage.

Medicare has designed Part D billing to be a part of that system. But two problems could crop up Jan. 1 that could make it difficult for people to get their medicines.

First, some seniors who've signed up for Medicare drug benefits might not be in the system yet. Second, some pharmacists might not be able to get into the system, or get it to work.

Regarding the second problem, Dillon at Grubb's pharmacy hasn't been able to access it yet, although some others have. He's working with his software provider on that and is nervously optimistic.

He says if everything turns out the way it's supposed to, things will be fine. "The confusion will not be on the electronic side. We'll be able to process prescriptions if we have the right information."

As to the whether each patient's information will be in the system by Jan. 1, Tom Clark of the American Society of Consultant Pharmacists, isn't sure. He thinks there are about a million people who aren't in the system yet. These are people who were on Medicaid and who were automatically assigned to the new Medicare drug benefit.

"The worry is there will not be adequate time to get data into the system," he says, "and to get the data verified and tested prior to the Jan. 1 beginning of the Medicare drug benefit program."

The reason he's so skeptical is the government has missed at least two crucial deadlines in the past few months as they set up the program: one on putting the plan descriptions on the Web and the other on getting certain information into the database. The Jan. 1 deadline is the most important one because that is when the program goes live.

Medicare chief Mark McClellan says all the computer data that needs to be there by Jan. 1 will be there.

There's a third problem that could crop up Jan. 1: Customers could have so many questions about their new plans — what they cover, what drugs cost — that there will be long lines of people waiting for service.

At Grubb's Pharmacy, Dillon says he's hoping his regular customers will fill their January prescriptions before the end of December — that is, if their insurers will let them get their medicine early.

He thinks he — and his Medicare customers — will make it through.

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