Making sure everyone makes the most of Medicare Part D

The job of the pharmacist is to make sure patients receive the safest, most effective, and most affordable drugs. Pharmacists are experts not only in medications and how they are managed in patients, but also in private insurance plans, public insurance plans such as Medicare, and insurance details such as co-pays, reimbursements, formularies.

In 2006, Medicare expanded to include prescription drugs in a program called Medicare Part D, giving Medicare-eligible patients, most of whom are elderly, a new, but confusing, prescription drug benefit.

Designed to introduce free market principles into health care, Medicare Part D lets patients choose from dozens of insurance plans offered by competing companies.

The problem is that everything about these plans changes from year to year. And selecting the right plan requires a lot of background knowledge and analysis of both insurance benefit details and drug choices if patients are to ultimately choose the best plan for their situations. It’s exactly the sort of problem to be solved by a pharmacist.

Ahead of the Medicare Part D implementation, Helene Levens Lipton, PhD, and Marilyn Stebbins, PharmD, both faculty members in the UCSF School of Pharmacy’s Department of Clinical Pharmacy, saw the looming problem: patients would be seriously challenged to evaluate and choose their Part D plan. The duo went to work solving the problem by creating a program to train pharmacists to help patients make the best Part D choices, focusing on patients with limited incomes and limited English skills.

Learn more about the Medicare Part D program from a 2017 story series.

“We compare plans and evaluate medications for patients, and then we determine if a change is needed and if so we enroll them,” Stebbins said. “We also enroll them in a low-income health care subsidy through Social Security (known as Extra Help) if they meet certain income and asset requirements.”

With the help of a $3.7 million grant from the Amgen Foundation, the program trained pharmacy students in all seven California schools of pharmacy that existed at the time on how the new policy worked. (There are now 13 pharmacy schools in the state.) As a result of the program, thousands of pharmacy students, now practicing pharmacists, learned how to navigate Medicare Part D.

While the grant ended, the program lives on, and it’s now a required component of the UCSF’s doctor of pharmacy (PharmD) curriculum. Each year, around a dozen outreach events take place at UCSF and in the community, to give elderly patients the opportunity to discuss their drug regimens and Medicare Part D needs with a UCSF pharmacy student, and pick a plan that’s best for them.

The program is geared at reaching the underserved, and making sure patients are comfortable discussing their health care situations. That often means bringing interpreters to help non-English speakers.

Levi Gadye

Faculty member Marilyn Stebbins, PharmD, (bottom left), demonstrates to translator Wanda Chiu (upper left), and PharmD students Kelsey Mott (center), and Megan Tsao (right), how to navigate a Medicare Part D database.

At a recent Part D event at a low-income housing facility in San Francisco, three UCSF pharmacy students and a UCSF nursing student joined two interpreters from the health interpreter training program at City College of San Francisco, and together helped several elderly patients navigate the complex drug benefit.

The counseling saves money and changes lives. One recent patient participant left his provider a phone message extolling the service. He shaved about $12,000 a year off of his medication costs through a new plan the pharmacy students helped him pick.

“About 90 percent of the patients we see save money,” Stebbins says, whose research on the program and its impact has been published extensively.

For the students, it’s a great way to become familiar with the intricacies of the health care system. “It brings policy to life,” Stebbins said.

From Medicare Part D in 2006 to Obamacare’s implementation in 2010 and the current political debates over “Medicare for All,” pharmacists will undoubtedly be required to navigate major health care policy changes during their careers. “As a country, we’re asking ‘how do we provide access to health care?’ so it’s vital these students understand this program and understand the costs and how it works,” Stebbins says.