Attention, Medicare Shoppers . . . - New York Times
The New York Times

January 10, 2006
Op-Ed Contributor

Attention, Medicare Shoppers . . .
By LISA DOGGETT

Austin, Tex.

THIS winter, Medicare recipients shouldn't limit their bargain-hunting to
post-holiday blowout sales. Despite its serious deficiencies, the new
Medicare
prescription drug benefit offers a myriad of savings opportunities, which in
my grandmother's case totaled more than $2,000 a year. By asking the right
questions and comparing plans, the savvy consumer can save more with
Medicare than at Macy's.

The new federal benefit subsidizes drug costs for the 42 million Americans
covered by Medicare. It's confusing and complex, but its bigger flaw is that
it prohibits the government from negotiating Medicare drug prices with
producers as the Veterans Administration does for our veterans. The plan's
estimated
$724 billion price tag over the next 10 years could have been substantially
reduced had the government retained its bargaining power. Instead, the
program
allows the insurance industry to develop for-profit plans, leading to an
overabundance of imperfect choices for the average Medicare recipient.

Choosing a plan is an overwhelming and cumbersome task. While many patients
lack the knowledge and skills to pick the most cost-effective plan,
overburdened
physicians can't be expected to counsel each individual patient with plan
selection. But for those Medicare recipients who are able, it is worth
taking
time to understand the options and investigate possible savings on their
own.

As most of my patients have low incomes and lack prescription drug coverage,
I have become an expert penny-pincher. My patients and I adjust medications
to less expensive, often generic, drugs. We look for coupons, break pills in
half, search for the cheapest pharmacy, find free samples and enroll in
patient
assistance programs sponsored by drug companies.

Now, my 88-year-old grandmother and I have used some of these same
strategies to reduce the price of her eight monthly prescriptions, which had
cost about
$260 per month, more than $3,000 a year.

Realizing the challenges of enrolling for someone who has never switched on
a computer, I offered to select a Medicare prescription plan for her. I
started
the process at the fairly straightforward Medicare Web site, and after
entering her ZIP code I learned that she had 48 plans to choose from, each
offering
different lists of covered medicines (known as "formularies"), co-payments
and deductibles.

After entering the names of her current medications, I was presented with a
list of estimated costs for several plans. To my dismay, the "best" plan
cost
$3,242 annually, even more than her current drug bill without any insurance.

But I didn't stop there. I studied her medication list and discovered that
with a few medically insignificant changes, she would reduce her total drug
costs
substantially. The key is understanding that most medications are considered
part of a "class" based on how they work, and each class usually includes
two or more medicines of similar effectiveness.

Often, a brand-name medication has a high prescription price, but another of
the same class that works equally well is available as a lower-priced
generic
or sold over the counter. The prices of most medications are difficult for
doctors to estimate, and we frequently don't mind making a substitution if
it
will enable the patient to afford the prescription.

Reviewing my grandmother's medication list, I removed just one medicine,
Prilosec, a heartburn drug. My grandmother was getting it by prescription,
but
since 2003 it has been available over the counter for less than $25 a month.
By switching to the cheaper version, my grandmother lowered her projected
costs, according to the Medicare Web site, to $1,945 annually, a net savings
of more than $1,000.

Further switches among prescription cholesterol and blood pressure
medications lowered her costs further, to only $960 annually if she chooses
to receive
the medicines by mail (or to $1,267 if she prefers the local pharmacy). I
found these savings by reviewing the formularies on the Web sites of several
different plans and switching her to medicines that were "preferred" under
the drug benefit. Once her doctor agreed to the proposed changes, we signed
her up.

The lessons for Medicare patients are clear: don't automatically enroll in
the first plan that pops up as your "best" option; compare the covered drug
lists
of your top choices (available on line or by calling the companies directly)
and discuss the options with your doctor or pharmacist; ask if there are
generic
versions for any of the medications and, when possible, avoid the more
costly drugs that are not "preferred" by the plan.

Even those who have already joined plans can still save money by bringing a
copy of their covered drug lists to their doctors to discuss switching to
cheaper
medicines in the same class that are "preferred." (Beneficiaries may also
change their plans during the next annual enrollment period, Nov. 15 through
Dec. 31.)

I realize that after navigating the Internet maze required just to enroll in
a plan, few Medicare recipients will relish the idea of doing more research
and making changes on their own. But the savings can more than make up for
the effort - just ask my grandmother.

Lisa Doggett is a family doctor.

Posted by Miriam V.