‘Hopelessly Complicated’ Benefit Plan Signup to Begin
By George Anderson
William Beard, a retired chemist with a Ph.D., told The New York Times, “it’s too complicated to suit me.”
Pauline Olney, a retired nurse, said, “The whole thing is hopelessly complicated.”
What Mr. Beard and Ms. Olney were talking about are the details of the federal government’s new Medicare D drug benefit program. The new plan will begin enrolling seniors tomorrow and will be available to beneficiaries on January 1.
The Bush administration has said that the program will help seniors covered by Medicare to cut their prescription medicine expenses by at least 50 percent, with lower-income consumers achieving far greater savings.
In a radio address on Saturday, Mr. Bush said, “This new benefit is the greatest advance in health care for seniors and Americans with disabilities since the creation of Medicare 40 years ago.”
Most appear willing to test the accuracy of Mr. Bush’s statement, but many say the complexity of the program makes its very difficult to determine which is the right drug plan to join.
Participants in most states have dozens of plans to choose from. They differ on drugs covered, premiums, deductibles and co-pays.
Retailers and others are holding Plan D workshops to help consumers cut through the complexity. Many pharmacists have participated in in-house as well accredited continuing education seminars approved by the Boards of Pharmacy.
Bernie Slome, vice president of business development for the mystery shopping and research firm ICC/Decision Services [a RetailWire sponsor], said that the complexity of the
program led his company to create an auditing program to help clients determine just how well pharmacists understand Plan D and are communicating that information to seniors interested
in joining.
“This is a unique opportunity for drug store chains to enhance their customer service and, ultimately, their sales,” he said. “Many people are unclear as to the particulars of the new rule; who better than the trusted pharmacist to explain the rules, thus giving comfort and assistance to the consumer who is asking.”
“If you don’t measure it, you can’t improve it,” he said.
Moderator’s Comment: Are pharmacies ready to counsel seniors on Plan D? Will the way pharmacies handle this have an impact on where consumers shop for
prescription medicines in the future? What retailers have impressed you with their communication efforts related to Plan D? –
George Anderson – Moderator
This whole thing immediately reminded me of that study, I think by Bill Bishop, where providing too many choices left shoppers either too confused to buy anything, or believing they actually had fewer choices. I bet a lot of people won’t read the brochure, and will just go to their pharmacies to be steered. So, sure there’s opportunity here.
When I read Plan D, all I could think of was why does the government provide a multiple choice, beneficial program in such a possibly intimidating wrapper to people who are trying to slow down? Most recipients will go to their local pharmacies for clarity. May those pharmacists do their homework thoroughly so they can counsel wisely.
Perhaps this new retailer function – teaching seniors about various prescription plans – will put to rest the ongoing debate in these spaces regarding the day-to-day usefulness of on-site pharmacists. Can our government position this as a way they’re supporting business, by driving more traffic to retail stores? They’ve already caused businesses to spring up around the daunting tasks of making Federal disability claims and qualifying for electric mobility carts, so could a business devoted to deciphering the new prescription benefit plan be far behind?
One of the points raised in the NY Times piece was particularly relevant. Apparently not all pharmacies will offer all plans. So the booklet sent to people’s homes will not always be helpful or relevant and explanations by pharmacists will be essential. Especially if they have made a decision themselves as to which plan is best for their customers and can explain why they recommend it.
The federal government sent a 100+ page book to everyone on Medicare. The book is needlessly confusing because it covers a number of Medicare-related issues, not just the drug plans. Since the listings vary by state, the books are not all the same. For example, the New York book lists 6 pages of drug plans, but to get to that section, you have to read 93 pages first. The first goal of good writing is clarity and it helps to state the most important facts first. Anyway, the book lists 23 providers who sell 125 different plans. The Sales Prevention Award for Health Care goes to HIP Health Plan, which lists no details and no phone number. Anyone presented with 125 choices of anything they’ve never bought before is likely to feel some confusion, especially since ALL the listings omit important details. In theory, a careful customer should call 22 providers (they can’t call HIP, which saves some time), and ask for all the information. Good thing most Medicare recipients are retired, since calling 22 insurance companies sounds like a full-time job.
The best thing any pharmacy could do: post a huge sign saying something like, “We accept all 23 Medicare drug plans.” Another idea: hire a systems company in Asia to write a computer program that analyzes every drug plan with all details for 50 states, and let seniors call in to list all the drugs they take. The operators could run the program for each senior and tell him/her exactly which plan is best. I see this as a multimillion dollar outsourcing sales opportunity.
The new plan D is not hopelessly complicated if people would take the time they spend complaining about it and read the information the SSA sent all eligible enrollees. As someone who is affected by this plan, I recently attended a seminar given by my Medicare Advantage HMO. When the 100+ in attendance were asked who had read the brochure, my hand was the only one raised.
The only complicated thing is the inability to know what the $ charge against your $2250 initial benefit will be for each medication you take by an insurer before you make your choice.
As for the poll question, the pharmacy’s materials will get less attention than the aforementioned SAA brochure mailed to every eligible household and, therefore, will have little or no impact.
In the end, the winning pharmacies will be those affiliated with the plans (both freestanding and HMO inclusive) that enroll the greatest numbers and, ultimately, stretch the $2250 benefit the furthest.
I have had the opportunity to speak to many people who have involvement with Medicare Part D. These individuals run the gamut from pharmacist to retailer to government relations to former government officials. To a person, they all feel that this is one of the largest initiatives they have ever encountered.
Whether or not the ACT is simple or not is not the whole issue. The perception, by both the public and the frontline dispensers of info, the pharmacist, is that this is not only complicated, but they also feel a time pressure. The pressure is felt for a number of reasons; a) short amount of time prior to beginning of enrollment to begin the education program to the consumer, b) enrollment deadlines for seniors in order to avoid higher premium costs c) shorter timeframes for seniors when a deductible is considered and d) the possibility that Congress may postpone this benefit.
The information sent by the SSA answered the basic questions. Now the fun begins…which plan? How does it compare against what they already have? How does one plan compare against another?
Almost every retailer has begun, and most have completed, the initial phases of training. Now, many are auditing those results. They are seeing where they need to enhance, review or retrain.
In the end, it is the retailer that gives the best assistance to seniors that will keep their business. That prescription drug business will translate into many more sale dollars of non-prescription products. Thus – best service means big sales increase!