Are We Aligned Yet? A Medicare Part D Roundtable - Pharmaceutical Executive


Are We Aligned Yet? A Medicare Part D Roundtable

Pharmaceutical Executive

On a more positive front, we anticipate that we will get a lot of new enrollments—the auto-enrolls, the duals, and low-incomes that will be signed up at the beginning of '06, and individuals that carry over from the type of programs we have today.

On the retail pharmacy end, there is the ongoing saga between the mail PBMs and the retailers. Some retailers, especially chains, are reaching out to the PDPs in a big way. They are becoming more and more our competitors. Initially this occurred in the private sector, but now it is really going to happen in the Part D world.

CLINTON: On balance, is Part D going to be a good thing for the various stakeholders or not?

ZANT: It's step one. Nobody knows what steps two, three, and four are going to be. It appears to be positive. It appears to be structured well with the parties involved, and has the potential so that it doesn't go down the wrong path.

DAVIES: And I think CMS is really open to the idea that all the segments of the industry should come together and try to leverage the strengths and minimize the weaknesses of the program, so it does go forward successfully. "

METRO: The consequences of failure are potentially much more complicated and worse than the consequences of success, if you will.

LONG: As I go down the line, there are pluses and minuses to every position. There are no slam dunks, which might mean Congress did a heck of a job. You're going to have to earn what you get. If you have your head in the sand, you'll be a loser.

SHERMAN: No matter what we all do, the benefit is very complicated, it's not easy to understand. And relative to the private sector, it's lean and mean. There is going to be a lot of complaining about it in the senior population, in part because of the fundamentals of the program design, regardless of how much industry participants rise to the occasion. That to me is perhaps the biggest obstacle.

SCHOCK: What we saw in being part of the demo project is that it is ever-evolving. The way you do things today is not the way you are going to do them tomorrow. That gives some of us in the pharma industry a bit of a concern.

WINTERTON: What happens in year one out of the gate is going to dictate what happens in year two, and that's going to dictate what happens in year three. The momentum of the program is going to shape the future of the benefit.

CLINTON: What would be the best outcome?

LONG: Enrollment.

WINTERTON: Enrollment and cost containment.

LONG: They won't know the cost until the second year.

WINTERTON: That's the problem we had in Medicaid.

DAVIES: If we consider enrollment to be paramount to success, it is important to make sure seniors understand the benefit. The people who need to guide those enrollees are the healthcare providers or physicians—because that is who patients are going to talk to—and retail pharmacists.

LONG: I think the pharmacists step up a lot more than doctors.

DAVIES: I think you're right. But it's important that the industry reaches out to them and ensures that they have accurate information, so they can guide those senior citizens to make a more educated choice. Part D is going to be difficult to understand. Seniors are going to be looking to people they trust, and they trust their pharmacists.

ZANT: Physicians have the up-front responsibility. But at the point where that patient is going to cross into the doughnut hole, it is the pharmacist who is going to see it on the screen. The doctor is probably not going to know.

DAVIES: The pharmacist may see that as a threat. They are overworked already, and now they are going to have to be a mentor and educator. There's the potential, if pharmacists are not really a valued part of the process, that they could become disenchanted and become a confounder that causes things not to go as smoothly.


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