Our Perspectives
Pharmacists could help with drug plan
By Joseph Guglielmo, Marilyn Stebbins & Timothy W. Cutler
This editorial originally appeared in the Oakland Tribune on May 14, 2006
The countdown to the May 15 enrollment deadline for the new Medicare Part D prescription drug benefit has been highly publicized in the media, but there has been little focus on the underprivileged and underserved populations. We live in a multi-cultural country where diversity is celebrated, where we speak Mandarin, Spanish, Vietnamese, Russian, English, and many other languages. Yet the U.S. government has focused the majority of its very modest educational efforts on Medicare enrollees who speak English alone and in forums that do not target Medicare enrollees with disabilities.
The process of evaluating Medicare Part D options and enrolling in a plan has turned out to be cumbersome, confusing, complex, and is often impossible for non-English speaking and disabled Medicare-eligible patients to navigate with any degree of certainty. Confusion reigns at a time that demands clarity.
In the absence of significant government attention to this issue, it is incumbent upon leaders in the healthcare community to help special populations understand the enrollment process both before the initial May 15 deadline—and beyond. Dual eligible patients with Medicare and Medicaid can switch plans every month if needed and all patients can change plans each year. And as patients turn age 65, a constant tide of patients will become eligible for Medicare Part D. This means that the confusion surrounding Medicare Part D will surely continue as patients switch and are switched from plan to plan.
Community pharmacists and pharmacists who teach in universities are well positioned to join forces to help address this confusion by working together to design, deliver, and assess Medicare Part D education programs that work.
Pharmacists are the only health care professionals trained specifically as medication experts. Most policymakers do not realize that today’s pharmacists hold doctoral degrees. Pharmacists are professionals who patients trust. They are patient advocates and educators. Many patients choose their pharmacy because it is close and convenient to their homes and because the pharmacists who practice there can meet their cultural and language needs. Pharmacists are available to patients at all times—in sickness and in health. Pharmacists are the essential links among patients, the healthcare system, providers, and payers.
As practicing pharmacists and university faculty members of the nation’s leading school of pharmacy, we believe that the government should immediately recognize and promote the “pharmacist as patient advocate and educator.” The government should engage pharmacists in broad and comprehensive Medicare Part D community outreach that includes non-English speaking patients, those with disabilities, and low-income patients. It is the pharmacist who is best qualified to help patients select the best and most affordable Part D plan while taking the opportunity to review patients’ medications and how they are being used.
Pharmacists can also ensure that all eligible patients enroll in Social Security’s low-income subsidy that helps pay for prescription drugs. Although Medicare estimated that 1 in 3 Medicare patients would qualify for extra help with their medications, less than 1 in 5 have been qualified to date. The reason? Many patients are unaware they qualify for the subsidy. Many others are confused by the program and are understandably unwilling to sign up. Medicare patients could easily be screened, educated about, and enrolled into the low-income medication subsidy by their community pharmacists.
The Department of Clinical Pharmacy in the UCSF School of Pharmacy has found that the most effective strategy for educating patients about Part D is one-on-one counseling with a pharmacist. Pharmacists already provide this personal counseling to patients of all cultures, languages, and income levels. Therefore, the pharmacist—drug expert, patient advocate, and multi-cultural health care counselor—is the obvious solution to the Part D education problem. The Centers for Medicare and Medicaid Services (CMS) should name the pharmacist as the primary educator of the Part D drug benefit for Medicare patients and particularly those with language, socio-economic, and cultural differences. To date, CMS has not called upon the pharmacist to advocate for patients, and the pharmacist is not recognized as the pivotal educator for this benefit.
The answer to the Medicare Part D education problem is to mobilize pharmacists nationwide, and give them the resources to develop, test, and mount this needed educational campaign. Pharmacists are already working quietly to help our tired and poor and disadvantaged masses—even if they don’t all speak English.
The government should engage pharmacists in broad and comprehensive Medicare Part D community outreach that includes non-English speaking patients, those with disabilities, and low-income patients.