Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D., The Medicine Men
Friday, Nov. 4, 2005

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This week The Medicine Men Column is short and not so sweet – that is, unless you like sugar-coated placebos. It's about one of the great ironies of America's governmental mad medical system. Not just 'the more you pay, the less you get' but 'the more medicine there is, the less you get.'

According to a 'News of the Day' release by The Association of American Physicians and Surgeons, Inc. (AAPS) on November 1, 2005, "Medicare drug plans may leave patients without their medications."

The problem is, as always, what the government will pay for. But this goes beyond the usual refusal to provide care. The release notes further that even if a drug is on a plan's formulary, a Medicare beneficiary may not be able to get it under the new Medicare Part D benefit. Patients may not discover this until they take their prescription to the pharmacy, at which time they will be locked into the plan for a year.

The formulary (medicines on a plan's pharmacy list) is only one of the cost-containment and -saving tools that a plan may use to restrict access. Others include prior authorization by the insurance plan (after physician and patient pleading); step therapy (or "fail first" with less expensive and less effective medications); and quantity limits that create more red tape for patients and doctors and may result in denials or critical delays in receiving medications.

The tools posted at www.medicare.gov are incomplete and may be misleading, according to the American Society of Consultant Pharmacists. ASCP has developed a document that explains the restrictions to medication access, posted at www.ascp.com/MedicareRx/docs/ASCPPartDMedAccess.pdf.

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Coverage of some drugs is excluded by Congress (e.g., barbiturates, benzodiazepines, nonprescription drugs). There are restrictions on all drugs in certain classes, including statin drugs, proton pump inhibitors, angiotensin II receptor antagonists, Alzheimer's disease drugs, osteoporosis drugs, agents for benign prostatic hypertrophy, and many others. More simply put: the ones you're most likely to use in your silver and golden years.

Writes Thomas R. Clark, Director of Policy and Advocacy for ASCP, "Physicians will also experience a tremendous administrative burden with the advent of Medicare Part D. They will be expected to contact Part D plans routinely for prescribing commonly used medications for Medicare beneficiaries. This heavy administrative burden could result in many physicians leaving the Medicare program, further exacerbataing the general lack of access to physicians experienced by many Medicare beneficiaries."

As Jane Orient, M.D., Executive Director of AAPS, known for her well-informed clear vision and straightforward thinking, told me this morning, "It's going to be a disaster."

So before you jump into another government plan, we suggest you carefully check your required medicines against the Medicare Part D benefit list and make a well-informed decision.

EDITOR'S NOTE: Michael Arnold Glueck submitted this week's commentary.

Contact Drs. Glueck and Cihak by e-mail.

Robert J. Cihak, M.D., is a Senior Fellow and Board Member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues.

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