Dr. Barry: Dollars to “Donut Hole”

Today, Dr. Barry Pascal takes a break from his usual comedic low road—well, almost.  He uses his combined experience as:

1. A pharmacist for over three decades;
2. A retired guy with a lot of time on his hands; and
3. An old guy with enough infirmities to require medication

to explore and demystify Medicare’s new drug benefits, as amended by the Affordable Care Act.  Follow his advice, and you might save enough for a decent Pastrami sandwich.  As always, you can find Barry‘s humorous works for sale here.—EGF

How to Take Your Medicine

By BARRY PASCAL, Pharm.D.
Humorist, Satirist, and All-Around Nice Guy

As you must know by now, I am a retired pharmacist.  So, I should know a lot about taking pills—firstly as a pharmacist, and secondly because I am now retired and most of us “retired folk” take pills.

Thusly, I come to you with information and tips from both sides: the “giver” and the “taker.”

My retired pharmacist buddies, Steve and Michael (we are known as “The Three Amigos” in Southern California pharmacy circles) and I spend a great portion of our time talking to each other about drugs.  When we were younger it was about how much they cost; which drug wholesaler had better prices; which drugs were in short supply; or the advantages of one product over another.  Now, we spend a lot of time talking about taking pills—which ones are now generic, about possible side effects, and the drugs covered by the various Medicare Part D drug plans.

For those of you who are under 65, Medicare Part D is the private insurance portion of the Medicare program that involves drugs.  Originally, it was probably called Part “D” for “Drugs,” but it is now “D” for “Difficult.”

If already enrolled in a Part D drug plan, members can change plans once a year.  The change period is from October 15 to December 7.  However, figuring out which plan to change to can be quite a task.  (The problems with finding a plan have existed since the inception of the program and were not created by the new health care bill widely referred to as “Obamacare.”  However, Obamacare has negotiated a benefit with the drug companies for all of us who are in the “Donut Hole”*—this year it amounts to a 52.5% discount off the price of brand-name drugs and 21% off generics.)

Michael, Steve and I started talking about changing drug plans last July.  We analyzed the medicines each of us was taking.  Then we compared each others drug plans.  Next, we called or saw all of our doctors and made all the appropriate drug changes; for example, changing a brand to a generic, or an expensive drug to a less expensive, therapeutic equivalent.  We may be retired, but we are still frugal pharmacists.  Well, before we knew it, we almost missed the December deadline.

We met at our favorite deli for several hours to decide what diseases we would probably get in 2013 and which medicines we would need for these new real or imaginary conditions.  It was a difficult process, so we decided we needed to meet at the deli several more times and work out the details.  (It’s funny how much clearer you think after a hot pastrami sandwich.)

After figuring out all our own plans, we had to tackle the hardest part of Medicare—figuring out our mothers’ plans.  Unfortunately, our mothers were taking 10 times the amount of medicines we were taking, and it was much harder to match the best plan with the best coverage and the best cost.  The good news is that our mothers really didn’t care and could not understand what we were talking about.  Not once did we hear that familiar old childhood phrase, “You did what?”

Medicare drug plans are not all the same; they have different formularies (the list of covered drugs for a specific plan); different network pharmacy providers; and different premiums, deductibles, and rules.  The most expensive plan is not necessarily the best, and the least expensive is not necessarily the cheapest.  It all depends on the medicines a patient is taking, the number of brand name drugs involved, and the plan’s formulary design.

Figuring all this out took us until December 6,^,2012, but we finally finished it and made the appropriate changes before the deadline.  Now, as long as nothing changes for a year, and we don’t get sicker and we only get a few of our new projected diseases, we are all set.  All we have left to do is the last part of the process—taking all the pills.

And that isn’t so easy, either.  Some pills make you sleepy but lower your blood pressure.  Some raise your blood pressure but help you breathe.  And, of course, some just make you sick and you don’t really know what they do.

I recommend that you ask your doctor a few questions whenever you get medicine or see your doctor—even if it is in the supermarket:

How long do I have to take this?

When should I take it?

What are the lousy side effects?

And, most importantly:

Is there something less expensive or better?

If you have not used up all of your visit time, you might also ask if any of these pills will change your personality.  Actually, no one really cares if your personality changes…if it’s for the better.  (In this context, “change your personality” in this means:

Will my spouse, friends, or significant other complain about me more or less?

Here are a few things to ask your pharmacist:

When should I take this medicine—at night or in the morning?

Should I take it with or without food?

Will it conflict with anything else I am taking or want to take?

And, lastly:

Will it change the flavor of Chardonnay or scotch?

(Also, before you change your Part D plan make sure you ask your pharmacist if they will be able to fill prescriptions on the new plan you are considering.)

Order your prescriptions early; most plans will allow you to refill a 30-day prescription after 23 days.  However, the most important thing to remember about medicine is to take it.  Many health care professionals estimate that 50% of all hospital admissions may have something to do with medication or drugs—taking too much, not taking regularly, taking another person’s prescriptions, and so on.  That is the one thing we Three Amigos do correctly—take our medicine regularly and at the right time—with Pastrami.

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 * Refers to the third financial segment of the Medicare Part D program.  The four financial segments of the 2013 Medicare Part D program are:

1. The Annual Maximum Deductible (the first $325 of total 2013 covered drug costs paid by patient);
2. The Initial Coverage ($986 total patient out of pocket paid, or $2,970 total 2013 covered drug costs paid);
3. The Coverage Gap or Donut Hole (the next $3,764 total patient out of pocket, or $4,750 total patient out of pocket in 2013 for covered 2013 drug costs paid); and
4. The Catastrophic Coverage (the patient Rx co-pay for the next 2013 covered drugs is the greater of $2.65 for a generic, $6.60 for a brand, or 5% of total allowed RX price).

Useful References:

Healthcare.gov — Affordable Care Act Timeline

H.R. 3590 – Patient Protection and Affordable Care Act

H.R. 4872– Health Care and Education Reconciliation Act of 2010

Medicare.gov – In General

Medicare.gov – Part D Plan Finder

Medicaid.gov– Affordable Care Act

Obamacarefacts.com — Facts About ObamaCare

Wikipedia – Comparison of U.S. & Canadian health care systems

Wikipedia – Health Care and Education Reconciliation Act

Wikipedia — Patient Protection and Affordable Care Act (Obamacare)

About the Author: Barry Pascal, North Valley’s former Honorary Mayor and Honorary Sheriff, owned Northridge Pharmacy for 32 years and is now retired. He has written seven comedy books and writes a humorous column for the California Pharmacists Association Journal as well as for the North Valley Community Connection.  Pascal is currently the health care advisor for both segments of Members of Congress—those who have not read the Affordable Care Act they voted on, and those who don’t understand it.

© Barry Pascal April 2013