Let's do our homework and have our choices

November 1, 2005

We all seem to be taking a wait-and-see approach.

Every year, I attend a dinner hosted by my church. This year, it just so happened that I sat at a table with a priest, a lawyer and a nurse (which almost sounds like the first line of a joke, right?). Somehow we got on the topic of Medicare Part D, and the emotions attached to the current period of uncertainty were no joke at all.

The retired priest observed that his existing pharmacy benefit provided comparatively affordable drug coverage and that he had no intention of signing up for Part D. The lawyer, who handles her elderly mother's affairs, said that she was confused by the Part D offerings and couldn't seem to get the answers she wanted. Some of the people she spoke to apparently refused to discuss her mother's situation in fear of HIPAA violation.

The nurse at the dinner table said she knew many people in the area were confused and was planning an information session with a guest speaker to help the community make sense of it all.

The national Medicare Rx Education Network, chaired by former Louisiana Senator John Breaux, who also leads a bipartisan group hoping to create a ceasefire between the two parties when it comes to healthcare, is also taking outreach education on a road tour through its individual state network branches. They represent seniors, patients, providers and businesses.

WAIT AND SEE

For those offering this new benefit, you must be feeling some anxiety as enrollment begins. The enrollment patterns are certain to impact long-term pricing structures. What if enrollment is lower than expected or if certain types of beneficiaries do not enroll? We all seem to be doing a lot of wait-and-see.

This has probably been your pivotal marketing month. Perhaps you've launched additional training for member service staff or increased your call center capabilities and personnel. You might have a powerful new Part D cost calculator on your Web site. Maybe you're planning your own educational events. Whatever your strategy, the urgency will continue. Like my companions at dinner, every enrollee will have his or her own set of needs and will search for the best choice-possibly waiting until the eleventh hour to enroll.

But the forecast is optimistic. Medicare officials are reporting a substantial growth of Medicare Advantage plans offering Part D benefits. Some offer low- and no-premium plans and are expecting most of their current members to sign on with the drug benefit, too.

Political ramifications will trickle down with the relative success or failure of Part D. The cost projections have changed several times, and CMS's model formulary will continue to change as new drugs and pharmacoeconomic data become available. Enrollment patterns will likely affect the future richness of the benefit choices moving forward.

I wonder what Henry Ford-known for his famous quote, "People can have the Model T in any color, so long as it's black"-would have said about Medicare Part D and the choices it offers consumers. If he knew that most regions have 18 to 20 stand-alone drug plan options-not to mention Medicare Advantage choices-would he find that overkill? Would he frown at the consumer kowtowing? I would hope not.

Just like many things in life, there's a tradeoff related to this drug benefit and the consumer-oriented movement overall. It's great to have choices, but now consumers have to do the homework. All in all, I think as Americans, we'd rather do the homework and have the choices. Otherwise, we'd all be driving black cars.

Julie Miller is editor-in-chief of Managed Healthcare Executive. She can be reached at julie.miller@advanstar.com