Rx for confusion

On Jan. 1, the federal government will begin subsidizing prescription drug coverage for people on Medicare, paying an estimated $720 billion over the next 10 years to 20 private insurance companies offering 47 coverage options nationwide. Within those options, deductibles can range from nothing to $250 and monthly premiums from $10.29 to $68.26. Some plans cover more drugs than others.

If that sounds confusing, it is -- and not just to people who are elderly. As of Nov. 15 seniors could begin signing up for one of the 41 Medicare Part D coverage options offered in Missouri. The enrollment period lasts until May 15. After that date, drug coverage will cost more for people on Medicare.

Last week, Cape Girardeau County announced it will offer all its residents a free discount prescription drug card that could save them up to 20 percent on medications. The card is aimed at helping those who are uninsured or underinsured. The card is not a substitute for Medicare Part D coverage, which is expected to save seniors without other drug coverage 23 percent on their prescription costs during a year. The card can complement Medicare Part D coverage, especially for those whose spending on prescription drugs falls into the Part D "doughnut hole" -- a gap between $2,250 and $5,100 in drug costs where benefits vanish. After $5,100 in costs, Medicare Part D pays 95 percent of the amount.

The new county program is being offered at a time when seniors already face a bewildering array of choices about how to save money on prescription drugs. The Area Agency on Aging is concerned that getting the county discount card might prevent some seniors from signing up for the Medicare drug coverage.

A spokesman for the National Association of Counties, which is providing the county discount card, reiterates the card cannot replace Medicare Part D. NACo solicited Caremark/AdvancePCS to administer the program because it is the country's largest pharmacy network and includes both large and small stores. NACo received no fee from Caremark, a spokesman says.

A number of area pharmacists are critical of the card, complaining that it will cost them money, and some contend their own prices can be lower than the discount card price. NACo spokesman Andrew Goldschmidt counters that pharmacies should benefit from the program through increased foot traffic. He says Caremark's price is lower than the pharmacy price 85 percent of the time.

So far, only four counties in Missouri have signed up for the discount card and only 150 nationwide. Each individual county decides when to roll out the program.

A concern is that someone who wants to judge how helpful the free county card might be could delay signing up for the Medicare Park D benefit by the May 15 deadline. After May 15, anyone enrolling for Part D benefits will pay 1 percent of the national average premium (currently between $32 and $35) for each month the deadline is missed.

By offering the discount card, the county intended to help residents. But for seniors the timing could not have been worse.