New Medicare Drug Benefit Takes Effect Alan Julius, a pharmacist at Valley Pharmacy in Cherokee, Iowa, talks about the first day of drug discounts for seniors and how that is affecting his pharmacy. Cherokee only has a population of 5,000 people, but his pharmacy is the county seat and serves many seniors from the surrounding area.

New Medicare Drug Benefit Takes Effect

New Medicare Drug Benefit Takes Effect

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Alan Julius, a pharmacist at Valley Pharmacy in Cherokee, Iowa, talks about the first day of drug discounts for seniors and how that is affecting his pharmacy. Cherokee only has a population of 5,000 people, but his pharmacy is the county seat and serves many seniors from the surrounding area.

ROBERT SIEGEL, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.

MICHELE NORRIS, host:

And I'm Michele Norris.

After months of discussion and debate, it's now official. Medicare's prescription drug benefit kicked in on Sunday. It's the biggest change in Medicare's 40-year history. To get a measure of how the new program is working, we decided to check in with a pharmacist in Cherokee, Iowa. Alan Julius is at Valley Pharmacy, and he's busy helping his customers adjust to the changes. And he joins us now.

Mr. Julius, how's it going? What's the scene at the drugstore today?

Mr. ALAN JULIUS (Valley Pharmacy): Well, typically this is our busiest day of the year, and it certainly is. But in terms of Medicare Part D, which most of the people coming in today have Medicare Part D, it's kind of at a slow crawl.

NORRIS: Well, what are some of the glitches in the system that you've seen so far?

Mr. JULIUS: Well, most of them do not have their cards yet, and they do not know what their ID numbers are. There is a process of checking for enrollment, but when we check, many of them are not in the system yet.

NORRIS: So they're not actually in the computer system yet.

Mr. JULIUS: Not in Medicare's system, no. And then the other issues are formulary issues, where if we do have a number that works and it's rejected because it's a non-formulary, the process is to call the provider, and they have a means of actually getting--the first 30 days would be covered.

NORRIS: The formulary, I guess, is the idea that each category of drug must have at least two options. But the problem, as I understand, is that those options might not include a drug that a patient is presently taking. Is that correct?

Mr. JULIUS: That's correct.

NORRIS: And that's where the problem kicks in.

Mr. JULIUS: Right.

NORRIS: How do you handle that?

Mr. JULIUS: Well, what each policy has is that we would call a pharmacy help desk and they would give us an override, so that we would allow them to fill that prescription for this month, and then we need to check with their doctor and see if we can change to one of their formulary medications.

NORRIS: So they get a 30-day grace period, essentially.

Mr. JULIUS: That's correct. But the problem is I have yet to find a help desk that I can get through to. They're all busy.

NORRIS: Ohhh.

Mr. JULIUS: They're all busy. If I don't get a busy signal, I'm put on hold. Actually I tried it yesterday. I was on hold for over two hours on one help desk and never got through. I have yet to talk to a person at any of the help desks.

NORRIS: Well, that's a long time for your patients to...

Mr. JULIUS: Well, it...

NORRIS: ...cruise the cough syrup aisle. I mean, what are they doing in that two hours?

Mr. JULIUS: No, they're not waiting. So in cases where they really need the medication, we're giving it to them, and we'll have to process it later when we can.

NORRIS: But when they have to change drugs, this can get very tricky. Things like congestive heart failure drugs or anti-depressants have to be very carefully monitored and calibrated. How do you handle those cases...

Mr. JULIUS: Well, absolutely.

NORRIS: ...when a patient has to switch drugs?

Mr. JULIUS: Absolutely. If the physician feels that that is medically necessary for that patient--OK?--and even though it's non-formulary, they can get prior authorization and override, and they could stay on that indefinitely if it's medically necessary.

NORRIS: So are the doctors on board on this? Because you have to call the help line, but you also have to call the doctors office to get a new prescription.

Mr. JULIUS: Then we have to call the doctor, and the doctor will have to call the prior authorization line.

NORRIS: Now based on what you're seeing, have your customers been adequately coached and prepared for these changes? Do they understand what's going on?

Mr. JULIUS: No, they're generally quite confused.

NORRIS: Well, do you have extra hands on deck to help people get through this process?

Mr. JULIUS: Well, today we do have four pharmacists and we do have extra technicians that are working. For how long we will need the extra help, it's difficult to say.

NORRIS: Mr. Julius, we've never met, but as I listen to you, I do detect a bit of stress in your voice.

Mr. JULIUS: (Chuckles) Well, you know, there probably is some, and my wife would attest to that. So I do anticipate there will be somewhat of a rough start; we anticipated that. I didn't think there was any way that we could have all of these people enrolled on the 1st day of January when many people were still enrolling up until the 31st.

NORRIS: Have you checked in with other pharmacists in the area or elsewhere in the country? Are they seeing a similar situation?

Mr. JULIUS: You know, I really haven't. I really haven't had time. But I would like to leave a message to my pharmacist colleagues that may be listening this afternoon: (Singing) `And may all your Part D nightmares be few.' Happy new year.

NORRIS: Maybe it's wrong for me to ask this of a pharmacist, but at the end of the day, are you going to be reaching for something yourself to take care of a headache?

Mr. JULIUS: I may after today, yeah, and I usually don't do that.

NORRIS: Well, Mr. Julius, all the best to you. Thanks so much for talking to us.

Mr. JULIUS: Oh, thank you very much.

NORRIS: Alan Julius is a pharmacist at the Valley Pharmacy in Cherokee, Iowa.

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