Zegerid
is one of those bullcorn “me too” drugs in the worst kind of way. If massive advertisements for it start as the “latest treatment for
heartburn,” it’s best to just put your fingers in your ears and shout “La la la, I can’t hear you la la la!”
Health Care Renewal has a great writeup on it
; it’s essentially the exact same thing as over-the-counter Prilosec or prescription Nexium, just mixed with baking soda, and dissolvable in water. (What a
breakthrough! Congratulations, Pharma!)
Although 42 doses of over-the counter omeperazole [Prilosec/Nexium] costs about $25 at retail, Santurus is selling 30 doses of Zegerid for about $140.
“That’s a lot to pay for baking soda,” says the significant other.
I had dinner tonight with
The Malcolm Gladwell
, and I say “The” like David Letterman says “I like The Doritos,” as if he’s a household name, because, well, he (Malcolm) kind of, sort
of… is. (My mom told me to say to him for her.) He’s the guy
with the big hair
that wrote
Blink
and
The Tipping Point
and writes for The New Yorker. He is long-time friends with a friend (Ann and husband Chris) and she was kind enough to invite me along to a dinner. He’s in the
area speaking today with Atul Gawande, another literary idol (he wrote
Complications: A Surgeon’s Notes on an Imperfect Science
) and several other great New Yorker pieces.
So I’m kind of totally geeked-up excited about meeting him as it were; and he’s, like, pretty normal. Felt totally comfortable talking to him (the wine
helped), and he was great to talk to. He’s interested in health care, so that definitely helped too; I find myself with less and less ability to relate to
anything non-medical. I explained my
cognitive dissonance theory to him
, it being my latest theory to try to figure myself out, and the night progressed through health care reform, when it will happen, how it will happen, and even a
little debate on Medicare Part D and the pharmaceutical industry. Although I still don’t fully
see eye to eye with him
on it, he convinced me on some points, and I’ll admit I didn’t know that generics were significantly cheaper here in the US. He also has an opinion on
when health care reform will take place in the US, but I don’t want to spoil it if it’s his next article. We also talked about board game strategy, the UK
version of The Office, and I ended up doing my terrible Cartman impression.
I think I’m infinitely envious of his job (or maybe more Atul’s–if I could read and write on fascinating things, plus do medicine, that’d be
the ultimate), but, like a lot of things, it’s probably less fun when you
have
to do it as opposed to doing it for
fun
. I think one of his greatest strengths is his ability to take the everyday experience, make sense of it, find some data behind it, and explain all the facets of it.
It’s almost like he writes things that you agree with on almost a “gut instinct” level, but then explains your gut away. (Me, I’m trying to
lose my gut.)
And the kicker? I email Ann back after the evening thanking her for the invitation, and I get a great one-liner back:
Before we start, I’d recommend getting your pill bottles or list of medications in front of you. And maybe a glass of water. This may take awhile. Here we go,
kids:
Hold down the shift key and
click on this link
. (When I say click, I mean take the left mouse button–or the only mouse button on some computers–and click.) This will take you to the Medicare
Calculator and open a new window, while leaving this one open. Here’s a clip of what you’ll see (without the pink and grey box):
That pink and grey box is your key. That usually means there’s something important. Click on that first link, “Compare Medicare Prescription Drug
Plans.” That’ll bring you here:
Now click on the orange arrow on the right side of “Find a Medicare Prescription Drug Plan.” Okay so far?
Next, if you’d like, you can enter all your info from your Medicare card in the top area that says “Personal Information.” To enter information
throughout this tutorial, you left-button click on the box where you’d like to enter information, and then start typing, just like this one:
For the general search, which will work just fine, click the “General Search” box:
Now it gets confusing. First, enter your zip code in the box. That’s #1 on the graphic.
The next step requires your own personal information. If you have some other way that you get medications–maybe through Medicaid, your previous or current
employer, etc, click the appropriate box. For most people, just click the box next to “None of the above.” It’s pink-grey highlighted as #2. (Any
box you check takes you to almost the same page anyway. Sigh.)
Next, are you qualified for an extra discount on drugs according to your income and the Social Security Office? If not, click “No,” #3.
Then click continue, #4:
Next, click “Choose a Drug Plan Type.” Keep going, you’re doing great!
Now they want to know if you have Medicare Advantage, also known as Medicare+Choice, which is already helping pay for your prescription drugs
now
. If you have no idea what I’m talking about, click the lower box, “Search for Medicare Prescription Drug Plans.” Otherwise click the top box. Now
you’ll see:
From here, you can start viewing the plans in your area. However, since the best deal you’ll get is based on the medications you take, I’d recommend
entering them in the system. If you don’t want to do this, just click “View Plan List.” If you’d like to follow my recommendation, select
“Enter my Medications.” Great!
Here’s why I had you get your medicine bottles out: You need to enter the name of each (either the brand name or generic name is fine) in Box #1. The click the
button (#2) to add the medication.
If all goes according to plan, the medication will appear down below, in this new pink-grey box #1. If there are multiple medications with the same name, or if the
system is confused about a generic name, it’ll make a display like in box #2. Simply click the medication name you wanted, and click box #3. Once you’ve
got everything entered and every medicine appears in box #1, click box #4. (Note: some medications will not be in the system, and I have no idea what this is. I tried
different medications, spelled correctly, and they couldn’t be found. I’m not sure what to do about this. I’m sorry.)
Once you click the “Continue” box, you’ll stay on the same page, but another box will pop up.
If you’d like to enter your specific medication dosage (10 mg or 20mg or 40mg, for example), click the “Choose My Drug Dosage” button. In the effort
of simplification, we’ll skip this step–besides, you can do it later if you’d like.
Likewise, if you want to pick up your meds at a specific pharmacy in your area, you can do that now with the “Select My Preferred Pharmacy.” But note:
certain plans may work with some pharmacies and not others. If you want the absolute lowest cost, click “Continue to Plan List.” If you want to pick your
pharmacy from one locally, click “Select My Preferred Pharmacy.” Also note: if you want to get your meds by mail, the Plan List page will show you which
plans will mail your drugs to you.
Finally! We’re on the list of your plans! They’re sorted by lowest yearly price. The rest of this just explains the final plan page with letters:
A: Click this box and up to 2 others to compare three plans. Click C to do the comparison.
B: Click this box for more options about the plan–the exact costs, how much you could save if you only used generics, enroll in the plan, etc.
C: See A.
D: Change your mind about wanting a specific pharmacy? You can do that here.
E/F/G/H: Here you can update the pill strength of each medication, or add more.
Now, if you want to sort the plans by something other than total yearly price, you can click on the column title and change it. Note that all these numbers really
depend on what drugs you take, so it’s important to enter them accurately. Remember,
Annual Deductible
is how much you pay until Medicare starts paying its 75% for your first $2,250.
Monthly Drug Premium
is how much you pay per month to take part in the plan no matter how many drugs you use, and
Monthly Cost Share
is how much you pay as a co-pay when you get the drug.
I really hope this helped someone. Damn long writeup by my standards.
The President of the United Auto Workers union
supports single-payer
, and makes a case for health care reform: how can American car manufacturers compete with other countries when GM has a
$61 billion
health care liability, and Toyota doesn’t?
Medicare, the insurance system for folks 65 and older, is about to get another addition tomorrow to provide prescription drugs to enrollees. There’s only one
problem: it’s a complete disaster, and should be an embarrassment to every Congressperson that supported it. The following is an attempt to make sense of
Medicare Part D in all its bureaucratic glory. I’m trying to write at a level anyone can understand, so you, or your parent, or your grandparent can understand
it.
It is not simple, and getting frustrated and confused is not a sign of stupidity.
A little background: Medicare has a couple parts. There’s Part A, which covers hospital care, and is pretty much automatic when the clock strikes midnight on
your 65th birthday. There’s also Part B, which covers doctor visits, and costs those that signup for it $78 per month. Almost everyone has Parts A and B.
There’s also Medicare Part C, which was passed in 1997 by the Newt Gingrich Congress, which allows people to enroll in an HMO for their Medicare, which can
provide them with prescription drugs. (AKA Medicare Advantage, Medicare+Choice.)
It could be its own post
, so I won’t delve too far. Now, most folks
love
Parts A and B, which, not coincidentally, most people have. You turn 65, you check a box on a form, send it in, and you’re covered if you go to a doctor or have
to be hospitalized. Easy as pie. Unfortunately, Medicare didn’t cover drugs, which are commonly needed by seniors, so the people said “We need drug
coverage.” And All Was
Good
Bad.
But this new Medicare Part D
isaster
is no simple box checking. A senior can’t just say “Yes, I’d like cheaper medications,” and then the government does that whole “Helping
the People” thing, because that’s the whole reason the People wanted the government in the first place. Medicare Part D requires a senior to compare
plans–up to 85 in one area–and choose one based on a number of different factors and numbers. (It should be noted that this system was made under the
guise of choice–
the bill was heavily influenced by lobbyists
. Take a second and ask yourself about the choice: do you honestly care which company provides your medications? Probably not. You just care that you can get them
cheaper and have access to them when you need a refill.) You might think that there’s no precedent for such a simple, straightforward plan without the
bureaucratic nightmare, but it’s not the case. There’s at least two: the Veteran’s Affairs hospital system and the state-run Medicaid program (which
provides insurance for the very poor). These systems are not perfect, but their bureaucracy causes headaches for administrators, not for patients. Also note this: the
law that made Part D specifically forbids Medicare from using its bulk purchasing power to get cheaper costs on medications for patients, but Medicaid and the VA both
do this, too.
So how is this Medicare Part D thing supposed to work? In a perfect world, a person picks a Prescription Drug Plan (PDP) from one of many offered by different
companies. That PDP pays for part of their drugs, after the senior pays for some as well. The PDPs differ on how much you pay per month, how much you pay up front,
how much you pay per drug pickup, which pharmacies you can get the drugs from, etc. As you can imagine, if you have multiple drugs, and your spouse does too, it can
be a total nightmare. But wait Vanna, there’s more: our nifty little terror here has another catch. For the first $2,250, you and Medicare split the drug bill
(Medicare pays 75%). After that, for the next $2,850 of drug costs, you, the patient, have to pick up the entire tab. Once $5,100 is reached ($2,250 + $2,850),
Medicare kicks back in, paying 95%. People call this donut coverage; you get to eat a bite until you get to the middle, then you get nothing, but then you get donut
again once (if) you get to the other side.
Seniors are completely confused by this Medicare Part D. (And if you’re even still reading, aren’t you too?) It’s almost to the point that Jeff
Foxworthy could do his redneck routine: “If you’re 65 and have recently pulled out your last remaining hairs, you might have Medicare Part D.” You
have people with advanced degrees not able to make sense of it. Heck, I have a background in health policy, I’m two years away from being a doctor, and
it’s taken me a good while to figure it out. If you don’t believe me, see
Medicare complexity may scare off seniors
or
Confusion Is Rife About Drug Plan as Sign-Up Nears
. Plus: A classic “screw you, seniors” quote from Michael Levitt, Secretary of Health and Human Services, who oversees Medicare: “Health care is
complicated. We acknowledge that. Lots of things in life are complicated: filling out a tax return, registering your car, getting cable television. It is going to
take time for seniors to become comfortable with the drug benefit.” Mikey, Mikey, Mikey… those things are complicated, but they shouldn’t be.
That’s no excuse.
I hesitate to even recommend the
Medicare website
, as it’s its own disaster, but I don’t like most of the other websites out there, and they don’t have a formulary list out there.
Terms
(also taken from
here
, and then I’ll explain the Medicare calculator. (
USA Today has a decent writeup
, too.)
Formulary
A list of drugs that a company or plan decides it will carry. If a drug is “off-formulary,” generally your doctor has to make a special plea to use it
and has to have a good reason. You also might have to pay more for it.
Deductible
What a Medicare member pays before drug coverage kicks in. Can be zero to $250 a year.
Medicare Advantage
Managed-care plans, such as an HMO. Medicare Part C. The plans may provide more services than traditional Medicare, but may limit members to certain doctors and
hospitals.
Premium
A monthly payment for insurance.
Quantity limits
Dispensing limits on the quantity of a drug that can be prescribed each month.
Step therapy
Step therapy means a patient must try a lower-cost, often generic, product first. If it isn’t effective, the patient then “steps” to a different,
often more expensive, drug.
Co-Payment (Co-Pay, Co-Insurance)
Amount you pay to get a drug after you’ve paid your deductible. Some plans have one flat rate, others have different rates based on the type of drug (brand
name vs generic, newer vs older, etc)
The government’s paramount goal in pushing a nationally-connected healthcare record is to be able to monitor and prescribe what kind of treatment everyone
gets. You might be 85 years old and not want a mammogram, but too bad. The system will make sure you are harassed until you get one.
She’s clearly never even *used* the VA system for a patient. Yes, it reminds you about screenings like colonoscopies and mammograms, but in two mouse clicks you
can turn the request off for any number of reasons. Add this to the fact that the VA does a much better job of screening its populations and doing diabetes follow-ups
*because* of its electronic medical record, and you’ll realize she just wants to create an evil government enemy to satisfy her libertarian needs. She complains
about a private insurance system, and then applies it to all medical records. (Also note that a recent Health Affairs study showed the US has the highest rates of
medical errors as well.)
Update:
Epiphanies
has more with some linked articles–didn’t have time to find them this morning. And she’s right about EMR technology needing to be user-friendly, but
this may be a case of a generation gap: I wonder if MedPundit’s generation is just not good with computers, and that’s the problem.
Doing a little self-reflection, I’ve found myself having more and more libertarian thoughts running through my head–usually of a “personal
responsibility” or “individual behavior” nature, and I’m trying to understand why they’re popping up. Here’s the theory; it may
explain why many physicians are somewhat libertarian in nature as well:
Physicians want to help people. In practice, I think, much of one’s ability to help is limited by patient adherence: we can only give suggestions to patients.
They can choose to take the medicines we prescribe, to get the additional tests we request. Many times I think we assume a patient doesn’t follow a care plan
because of some intrinsic personality characteristic–when often it’s a problem with understanding or other situation that prevents perfect adherence. Many
times things totally unrelated to medicine influence a patient’s ability to get care. If they don’t have transportation, how can they get to their doctor?
If they don’t have money, how can they pay for medications–or even co-pays? If they don’t live in a good neighborhood, how can they be expected to
eat fruits and vegetables, or get exercise if there are no safe places to work out, or no gyms in the area? If they lack the education and we don’t talk at a
level they understand, how can we expect them to participate in their care? If we don’t have a translator, pantomiming and charades only goes so far.
So I think a lot of the time physicians feel like their work is in vein. The realm in which we try to help is that of the individual. So if an individual
doesn’t follow-up appropriately, or doesn’t take their medications, we assume it’s an
individual
problem. We’re so intent on seeing that one tree that we forget that it exists in a forest. I think if more physicians took this approach (or maybe if more
medical students were taught with this approach in mind), we might have more physicians advocating for institutional, society-wide changes in the foods our patients
eat, the ads they see on television, and the lifestyles that they live.
Blogging is probably like sending angry emails: you should wait until you’ve calmed down. But I just can’t help it right now. I’m livid.
So I’ve become something of a patient advocate recently with all this geriatrics and frail elders and polypharmacy and whathaveyou, so I thought it’d be a
good idea to try to get a grip on the
Medicare Part D
stuff that’s going around to physicians and Medicare recipients. (My father and grandma tried to attend an information session, but it was so crowded even at
the encore performance that they couldn’t get in. Note: this is not a testament to how popular the new plan is; it’s a testament to how damn bureaucratic,
confusing, and complicated the thing is.) So I do a Google search for
medicare part d
to get some general results. I get a
ton
of ads (a clear sign that there’s money to be made by all comers), and I click on some ads, some links. A mish-mash of everything to get an overview, and
possibly recommend a site or two to my one or two readers.
I come to my first site, and this is the one that drives me over the edge:
AARPMedicareRx.com
. I see AARP in the URL, and assume it’s a special site the
AARP
has created to help its members. Then I see the AARP logo in the top left corner, and assume I’m right. I click on “Learn the basics,” and get this
first paragraph:
If you’re eligible for Medicare, you have a new option for getting coverage to help with the cost of prescription drugs: AARP MedicareRx Plan is a
prescription drug plan that is approved by Medicare. This national plan is provided by United HealthCare Insurance Company* and begins January 1, 2006.
I’m confused. “What? I thought there were multiple options for the Medicare Part D plan, not just one.” I re-read, I scroll down to the asterisk,
and reailze I’ve been had. This is not an AARP site at all; no, it’s a United HealthCare Insurance Company website with an AARP (“pharmacy
services” bullshit) logo. And if a third year medical student with a major in health policy and a pretty good understanding of the US health care system makes
this mistake, you can bet countless others will, too. I’m sure that’s the goal. Show the AARP logo so you get the confidence of the AARP, then tell
consumers there’s *one* new plan to help people out.
I’m disgusted. If anyone knows who I could contact to complain about this blatant deception, please let me know. (Isn’t this what the copyright laws were
supposed to be for? Protecting consumers from misleading or fraudlent information?)
Polypharmacy
is the taking of multiple medications for multiple medical problems. My winning patient so far had 24 when I saw him in clinic on Wednesday. If anyone honestly thinks
that patients are taking all of those medications, with all of their different schedules (two of this one in the morning, 1 at night; 3 of this one every 8 hours;
one-half tab of that other one every day), they’ve got to be kidding themselves. How many of us can reliably even take a course of antibiotics for 10 days?
Prevention is the only solution, people. Eat better, exercise more, stop smoking, and wash your hands. That’ll lead you to a healthier life than any pill.
