Embargoed for release until:Thursday, September 7, 2006
For further information contact:Craig Palosky, (202) 347-5270 or cpalosky@kff.orgLarry Levitt, (650) 854-9400 or llevitt@kff.org
Pharmacists and Physicians See Real Benefits from Medicare Drug Law, But Most Think it is Too Complicated and Report Customers and Patients Experiencing Problems
Substantial majorities of pharmacists (86%) and physicians (71%) believe that the prescription drug law is helping people on Medicare save money on their medications, according to two new national surveys conducted by the Kaiser Family Foundation.
At the same time, pharmacists (91%) and doctors (92%) believe the law is too complicated. A majority in both professions report that Medicare beneficiaries who they see are encountering problems in getting their medications, sometimes with serious consequences.
“We have surveyed seniors many times, and now pharmacists and doctors, and the story is remarkably consistent: The benefit is providing help to millions as intended, but there are also problems, and the complexity of the law is an issue for many,” said Kaiser Family Foundation President and CEO Drew E. Altman, Ph.D.
The two surveys were conducted between April and July, during the first year of Medicare’s new drug benefit. Nationally representative samples of 802 pharmacists and 834 doctors were surveyed. Each survey has a margin of sampling error of plus or minus three percentage points.
Majorities of pharmacists and doctors say that at least some customers and patients have encountered problems getting needed medications through their Medicare drug plans, with smaller shares reporting seeing more frequent and serious problems.
- Eight in 10 pharmacists (81%) say that they have had customers who had problems getting their prescriptions. One in five (19%) say such problems affected “most” of their customers in Medicare drug plans.
- Two in three pharmacists (67%) say they had customers leave the pharmacy without a medication because the prescribed drug was not on their Medicare drug plan’s formulary.
- Almost six in 10 pharmacists (58%) say they had customers pay out-of-pocket for their drugs because they could not verify their enrollment in a Medicare drug plan. Nearly half of pharmacists (49%) say they had customers leave without a prescription because they could not afford the co-pay charged under the Medicare drug plan.
- Nearly half of pharmacists (45%) who serve “dually eligible” beneficiaries, who were previously getting coverage through state Medicaid programs, say that these customers experienced more problems filling their prescriptions than other Medicare customers.
- Among doctors with patients in Medicare drug plans, 59% say that they have had patients who experienced problems getting their prescriptions, with 15% saying “most” of their patients in Medicare drug plans had such problems. One in 10 (10%) say that they had a patient who suffered a “serious medical consequence” as a result of such problems.
Assistance for patients
Pharmacists and, to a lesser degree, physicians report a willingness to help their customers and patients resolve issues related to their drug benefit – with 85% of pharmacists and 57% of physicians saying that they have “a lot of” or “some” responsibility to advise people about their Medicare drug plans.
A large majority of pharmacists say that they have helped customers navigate the system. Most pharmacists say they have talked to Medicare customers regarding concerns about the out-of-pocket costs of their drugs (84%), helped a customer to decide whether to enroll in a Medicare drug plan (77%) and helped to figure out whether a specific drug was covered by their plan’s formulary (75%).
Pharmacists report experiencing a number of administrative challenges under the Medicare drug benefit, which is provided by dozens of different private drug plans in each state, each with its own formulary, cost-sharing requirements and other restrictions. At least half of pharmacists say dealing with utilization management controls (57%) or getting through to hotlines run by drug plans (50%) are major problems.
Perhaps significantly because they are expected to help patients manage their medications, doctors report having little knowledge about the plans’ formularies – with 69% saying that they are not too familiar or not at all familiar with them, and 59% reporting that they rarely or never check a formulary before prescribing a specific drug to a Medicare patient.
“While seniors might expect their doctor to know when a prescription is covered by their Medicare plan, that’s generally not how it seems to be working,” said Vice President Mollyann Brodie, Ph.D., the director of the Foundation’s Public Opinion and Media Research program. “Seniors may not find out until they show up at the pharmacy.”
Administrative and financial burdens for providers
The survey also examined the administrative and financial burden of the new drug benefit on pharmacists and doctors. Most pharmacists (53%) say the new Medicare benefit resulted in “a lot” of administrative burdens for them. The same share (53%) say that the administrative burdens associated with the Medicare benefit are worse than those associated with commercial insurance. Independent pharmacists, who often are business owners rather than employees, are more likely to report “a lot” of burden (65%) than their counterparts who work at chain drug stores (48%).
Many independent pharmacists also say that the new drug benefit caused financial challenges for their pharmacies. More than one in four (27%) say that they had to take out a loan or a line of credit because of cash-flow problems related to the Medicare drug benefit. About three in four independent pharmacists say both that they have dispensed prescriptions to their customers without knowing whether they would be paid and that the reimbursements they receive from Medicare drug plans are less than what they get from commercial payers.
One positive cited by pharmacists are the electronic systems used to verify key information when filling customers’ prescriptions. More than eight in 10 (82%) of those pharmacists whose computer systems are set up to electronically verify enrollment information say the system works very or somewhat well. A similar share of pharmacists (86%) whose systems allow them to electronically verify formulary information say the system works well; however, little more than a third (38%) have systems that are able to perform such electronic verification.
Among doctors, about one in four (27%) say helping patients make decisions and get their drugs under the Medicare drug benefit resulted in “a lot” of administrative burdens for them and their staff. Among doctors with patients enrolled in Medicare drug plans, 46% say that the burdens of dealing with prescriptions under Medicare drug plans are worse than those associated with commercial insurance.
Findings from the surveys are available online.
Methodology
The Kaiser Family Foundation National Survey of Pharmacists, conducted April 21 through June 27, 2006, is based on a nationally representative random sample of 802 pharmacists working in independent retail, chain retail and HMO pharmacies. Once the sample was drawn, selected pharmacists were given the option of completing the questionnaire by telephone or online. The sample frame was developed using Medical Marketing Services, Inc.’s Pharmacist/Pharmacies list. This list of almost 200,000 pharmacists contains every pharmacist working in pharmacies listed in U.S. telephone directories and is updated every 60 days. The final sample includes 548 chain pharmacists and 222 independent pharmacists.
The Kaiser Family Foundation National Survey of Physicians, conducted April 25 through July 8, 2006, is based on a nationally representative random sample of 834 office-based physicians involved in direct patient care with adults. Once the sample was drawn, selected physicians were given the option of completing the questionnaire by telephone or online. The sample frame was developed using the American Medical Association’s Physician Masterfile. This list contains over 800,000 physicians and is considered the most thorough source available for physician lists and statistics. Excluded from the sample frame were: 1) hospital-based physicians; 2) pediatrics and related specialties; and 3) specialties not involved in direct patient care (mostly anesthesiology, radiology, pathology and related specialties).
Kaiser Family Foundation staff designed and analyzed both surveys. Data were collected by Princeton Survey Research Associates International. The margin of sampling error for the full sample in each survey is plus or minus 3 percentage points. For results based on subsets of respondents the margin of sampling error is higher. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll.
The questions about Medicare drug plans were part of surveys designed and analyzed by the Foundation to assess the views and experiences of pharmacists and doctors on the new drug benefit and other topics. Portions of the surveys related to other topics will be released later this year.
The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.
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