November 23, 2005

Q:  My 72-year-old father is bi-polar and has emphysema. I’m concerned that he will have to switch medications if he enrolls in one of the new Medicare drug plans. After years of trying several different medications, I don’t want dad to have to try other drugs that we know don’t work. What should we do? --Ann

Dear Ann,

You are asking a really important question. For millions of people on Medicare, finding a plan that covers the specific drugs they take – especially those that are relatively pricey – will be a top priority. Your dad could be on the hook for the cost of any prescriptions that are not covered under his new Medicare drug plan.

You and your dad will have to do some legwork to determine which plans cover his drugs and at what cost. A good place to start is Medicare’s website, www.Medicare.gov, which allows you to enter specific drugs to see if they are covered by plans offered in your area. You can also call 1-800-MEDICARE to get help, or contact the Medicare drug plans directly to ask if they cover the drugs your dad takes.

In addition to asking about which drugs are covered, it is also important to ask what your dad will pay for his prescriptions, particularly his most expensive medications. It might also be a good idea to find out if the plan imposes any restrictions on the specific drugs that your dad takes. Some plans have quantity limits, for example. It’s better to know now – before he signs up.

If your dad enrolls in a plan that does not cover one of his drugs, the plan may make an exception, but only if he can prove that similar covered drugs do not work or cause serious side effects. If that doesn’t work, your dad or his doctor can appeal the plan’s decision, but it would be easier to find a plan that covers all of his prescriptions.  

Medicare prescription drug plans are allowed to make changes throughout the year, so there is a possibility that your dad’s plan will stop covering one of his drugs. If that happens, the plan is required to send your dad a notice 60 days before his coverage stops, but your dad would not be able to switch to another plan until the following year.

This column was prepared by the Kaiser Family Foundation, an independent, non-profit private foundation based in Menlo Park, Calif., that is not affiliated with the Kaiser Permanente health plan. Do you have questions about the new Medicare drug benefit? Send your questions to Medicare Q and A. The Kaiser Family Foundation. 1330 G St., NW. Washington, DC  20005 or MedicareQ@kff.org. 

(c) 2005, Knight Ridder/Tribune News Service.

Distributed by Knight Ridder/Tribune Information Services.