Talk:Medicare Part D

medicareadvocacy.org links

The http://www.medicareadvocacy.org/ links are all broken.

What is a formulary?

• EOM
• The best article currently on wikipedia explaining a formulary is British National Formulary, which is not that great and obviously is specific to England. A formulary is a list of drugs that one specific plan through a specific provider will cover. Medicare D has a formulary and then the different providers can cover a percentage of that - usually about the low 70% range on the very low end all the way up to 100% (with restrictions of course) in the case of certain plans available through Humana and AARP-United and a few others. Does that answer your question?--Hraefen 17:44, 21 February 2006 (UTC)

Part D does not have a formulary. A formulary includes an explicit schema detailing exactly what drugs are covered, and under what conditions, including such things as cost sharing level (copay). Part D coverage instead has interpretative exclusionary regulations, based in US law, which some have mistakenly described as a formulary. As an example of efforts to make clear that there is no formulary legally authorized for Part D, the legislation recently passed by the US House as "H.R. 4 - Requiring Medicare to Negotiate Lower Prescription Drug Prices" as part of the Speaker Nancy Pelosi's 100-Hour Plan explicitly states that the bill does not authorize HHS to establish or require a particular formulary.[1] There would be no need for this wording if a formulary currently existed. However the individual plans do establish their own formularies, within certain restrictions governed by CMS. -- 12.106.111.10 23:23, 1 February 2007 (UTC)

I wonder about the neutrality of this page

Although there is an entire section dedicated to the implementation issues of Medicare Part D, there is no section reporting on the progress it has made or the possible advantages it may have (projected costs, although initially higher, have been estimated to be lower as of late, impacting possible clawback rates). Of course, state-sponsored dogma such as Secretary Leavitt's frequent Part D updates is undesirable, but the future of the plan is very much in question and there are arguments for how it may outperform other nations' prescription drug benefits (as well as those mentioned in this article for how it may ultimately fail). In the next few weeks, I will endeavor to unfold some of these arguments, but if anybody is an expert in the area, they could help flesh out this description. Poa02003 16:40, 11 July 2006 (UTC)

The total number of participants does not add up. "31.8 million in Medicare, 5.4 million other sources." The total number is supposed to add up to 38.2 million. But my math says that 31.8 + 5.4 = 37.2. My knowledge in health care is not as good as my math knowledge so can someone find the correct numbers and make proper adjustments please. Thank you. Goadhatesmyspace 00:27, 13 February 2007 (UTC)

Dual Eligible

Can anyone direct me to info that claims duals can move plans monthly? This has not been my experience as I handle Part D for a fortune 500 company.EmDeeEm 23:49, 12 September 2006 (UTC)

I can't find a citation unfortunately, but our Part D enrollment director tells me that fully subsidized individuals can can plans as often as once a month with no real limitations. LIS folks who are not fully subsidized can only change once a year. Again, apologies for the lack of a cite, but she forwarded on some examples that emperically showed that it can happen. (Though given what we've seen from CMS, this could be a quirk rather than policy...) Jargent 13:49, 21 November 2006 (UTC)

I work for a Medicare Health Benefit provider as a work contect specialist. Individuals who are dual elegible recieve a Special Election Period, that allows them to change services as often as they like for as long as they are dual eligible, see this excerpt:

Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment 30.4.4 - SEPs for Exceptional Conditions (Rev. 66, Issued: 08-05-05, Effective: 08-05-05)

5. SEP for Dual-eligible Individuals or Individuals Who Lose Their Dual-eligibility - There is an SEP for individuals who are entitled to Medicare Part A and Part B and receive any type of assistance from the Title XIX (Medicaid) program including full-benefit dual eligible individuals, as well as those eligible only for the Medicare Savings Programs (QMB-only , SLMB-only, and QI). This SEP lasts from the time the individual becomes dually-eligible and exists as long as they receive Medicaid benefits. The effective date of an election made using this SEP would be dependent upon the situation. In addition, MA-eligible individuals who are no longer eligible for Title XIX benefits have a 3-month period after the date it is determined they are no longer eligible to make an election. Rick (Humana)

Donut hole

Medicare spells it "donut hole" here. Perhaps we might be consistent with the name the government is using? --Chrispounds 20:22, 17 November 2006 (UTC)

I love to ignore the term in most cases as replace it with "coverage gap", which Chrispounds has done. It needs to be in there somewhere so people can find it while searching, but do(ugh?)nut hole is one of those terms that CMS only reluctantly uses. (You'll only find one other donut reference on the medicare site, while Coverage Gap appears 500+ times.) As for which one is "correct", the two are interchangable, and both valid. You could probably make an argument for using both so the article will pop up on either search term. In all, I don't think it matters much. -- Jargent 13:44, 20 November 2006 (UTC)

Also, FYI, I've created a Donut Hole (Medicare) stub page. I can see arguments for keeping/merging that info into the main Medicare page, but I think it's a term with enough life to get a page of its own. The link is also on the Doughnut (disambiguation) page. Have fun with that one.  ;) Jargent 14:14, 20 November 2006 (UTC)

Missinformation?

Perhaps it's against my better judgement, but I'd like to mention that I work for Aetna Inc. The literature we've been trained on states that medicare maintains a formulary list and that legally all part d carriers must conform to this list. Several of the customers I’ve spoken to disagree with this & so does this article. Looking at the reference cited (ref 13) I can’t find any place where it’s directly stated otherwise, though the wording seems to suggest it indirectly. Does anyone have a more direct reference for this piece of information?

Try the CMS part D PDP finder. Search for a few common drugs and look at a few of the plans links, it will tell you if they cover the drug or not. for most drugs, some will, others will not. does that answer your question? Pdbailey (talk) 03:31, 9 April 2008 (UTC)

Losing encyclopedic tone?

I think some of the recent (April 7-9, 2007) edits by Nbauman contain some interesting information, but I think they also turn the Wikipedia entry into an Anti-Medicare Part D propaganda piece. For instance, the first line of the Program Specifics heading is now a quote about how confusing the options are. I have no issue with putting attributed quotes about problems with Medicare in the Criticisms section, but the latest additions compromise NPOV. I'm going to tag the article as such for now until we get a better edit.

Let me be clear, I support keeping a lot of the added information in the article, but would prefer a more objective reading in the body, limiting criticisms to the criticisms section. Another example: The number of members enrolled in Medicare Part D is fairly objective. The fact that the vast majority of those members did not enroll voluntarily is relevant, but I feel it should be in a separate section. Happy to challenged here. Jargent 16:37, 11 April 2007 (UTC)

Medicare Advantage Perscription Plan

While they are certainly related sounding plans, medicare part D is different than the perscription plans provided under the medicare advantage plans. 75.132.36.150 15:15, 12 August 2007 (UTC)

Other resources

I want to discuss this in Talk first before deleting those links again.

King Vegita said, "partial rv. I checked those two sites desparately to find them selling something, both are offering free advice. There is no justification to delete them.)"

First, if you check Patient's Digest more carefully, you'll see that they have advertising. There was an ad for Lipitor on the home page when I last looked at it.

Second, more generally, there are thousands of web sites that offer help with Medicare Part D. Why should we recommend those two? In Wikipedia terms, I would ask, why is this source of information WP:NOTABLE? Neither of these 2 web sites is notable -- certainly not in comparison to the Kaiser Foundation and all the others.

I use the http://www.hon.ch/HONcode/Conduct.html principles. One of the principles is full financial disclosure -- the web site has to tell you where they get their money from. Many web sites are run by drug companies, or other medical companies that are trying to promote their products and services. If they don't at least disclose that, they're unethical, and I will delete the links.

In particular I look at the About Us box, to see who's running the web site and why. For example, http://www.patientsdigest.com/content/about.php shows that they're run by a pharmaceutical communications company. Drug companies are entitled to promote their products, but you can't expect a salesman to be objective.

Same with http://www.medicaresaver.com/home/index.htm. Who are these guys? They don't even say. They violate the HON principles by not disclosing their funding sources, among other things.

How do you know they're objective? How do you know they're reliable? You don't.

Basically it comes down to WP:NOTABLE. They're two sites that are not distinguished in any way, that have nothing objective to recommend them, and are less notable than every other site on that list. Do you know anything about them that I don't know?

Is that a good enough reason for you? Unless somebody has further objections, I'm going to delete them again. Nbauman (talk) 17:47, 22 March 2008 (UTC)

Both appeared to be run by pharmacies, who seemed interested enough in making sure that the seniors get a good deal, because they make money if the right drugs are covered. They did not seem to support any specific company or set of companies, and certainly would be better than the Kaiser foundation, which would have its own plan..... There are ads on the page for the second one, but not for their own product. That's no different than linking CNN or Google or just about any website out there unfortunately. We don't know if these two sites specifically are notable, but they would be about as notable as the CVS site, and anything other than a SHIP or Medicare's website. Since we're including those others, it doesn't seem sensical to delete the others that aren't specifically promoting. When you removed them, you called them obvious spam, whereas I did not see that they were spam, but rather some site I never heard of that seemed to meet the criteria enough that I didn't delete it when I was looking for something to delete. Now, I don't care if they stay or go, but if they go, there should be an illustrated difference between them and other sites like that or we stick to the SHIP and Medicare's site for finding plans. You may be able to do that easily, but I'm going off of what I can and cannot see without in depth research into every link listed.KV(Talk) 18:45, 22 March 2008 (UTC)

Why not do a simple search on these websites? The 10 Google resullts on medicaresaver and 22 for patientsdigest will tell you all you need to know why they don't meet WP:EL. Another way to determine notability is to check to see if notable news sources are quoting the websites or its significant contributors/owners, or if the only mentions (or highly ranked results) are junk websites or press releases picked up from PR distribution services. Flowanda | Talk 00:42, 23 March 2008 (UTC)

Point of fact: The Kaiser Family Foundation is no longer associated with Kaiser Permanente health plan, as its WP entry notes. I'm not sure about CVS, because I didn't examine it enough to know whether it's useful, but if somebody does I'd tend to go along with their judgment.

I think we need an affirmative reason to include an entry in external links. It's not enough to say, "I found this on the Internet and it looks good." It has to provide something particularly useful that we can't get anywhere else. I don't think those links meet the test. Do we have consensus? I think so. Nbauman (talk) 04:57, 23 March 2008 (UTC)

I've again removed the nn links discussed above, plus the cvs link, since it seems like basically a sales prospecting tool (at least that's what I got when I filled out the online form). I also added some modifiers to some of the other links that included commercial sponsorship (such as the Dole site). The Aging-sponsored site should also be updated to include drug company sponsorship as well. I don't particularly think these links should be removed, but just be more clear about their associations. Flowanda | Talk 17:04, 26 March 2008 (UTC)

Cost of Medicare prescription drug insurance has risen 756% in 3 years!! It is a major bait-and-switch scam.

I am an 86 year old WWII veteran (100th Infantry Division). In January 2006, my wife and I signed up for the basic Medicare Prescription Drug Insurance from Humana (one of the providers of that insurance) at a cost of $5.41 per month per person.

By January 2009, the monthly cost has risen to $41.90 per person. That is a 756 percent increase in 3 years!! That is not "free market capitalism" ... it is outright "highway robbery" !! We seniors are being abused by such despicable bait-and-switch tactics.

I believe it would be appropriate to include a discussion of the exorbitant price increase as a new section of this article. Not to do so would be a sad omission. mbeychok (talk) 21:21, 4 March 2009 (UTC)

Old People

Oh, WAAAH, my premium went up! I'm old! And a Veteran! Do me a favor -- stay the HELL away from my pharmacy. And everyone else's, too. I'd be willing to bet it's a real picnic dealing with you at the counter.