Two provisions of the Affordable Care Act, better known as health care reform, impacting Medicare beneficiaries' prescription drug costs have gone into effect since the bill became law in March 2010.
In 2010, nearly four million people with Medicare who found themselves in the Part D coverage gap (also known as the donut hole) received a one-time, tax-free $250 rebate check.
Healthcare.gov statistics
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David Zimmerman
--There were 10,898 North Dakotans who received the $250 rebate in 2010, with the total amount totaling $2,724,500.
--The U.S. Department of Health and Human Services, through the Affordable Care Act, is working to close the donut hole by 2020. Beginning in 2011, the Affordable Care Act provides a 50 percent discount on covered brand name prescription drugs to seniors and others with Medicare who find themselves in the donut hole. This discount is automatically applied to any brand name medications purchased by beneficiaries while in the donut hole. For the 11,000 beneficiaries with the highest out-of-pocket costs, savings have averaged $1,775 per person (U.S. Department of Health and Human Services, 2011).
Other changes
Additional changes to Original Medicare implemented since Jan. 1 include:
--Providing a free annual wellness visit; in the first six weeks of 2011, more than 150,000 beneficiaries benefited from this new option (U.S. Department of Health and Human Services, 2011).
--Making critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, available for most people with Medicare, at no cost.
--Giving qualifying doctors and other health care professionals that provide primary care to people with Medicare a 10 percent bonus for primary care services. This will help ensure that primary care providers can continue to offer professional health care services to Medicare patients.
Participate
There are so many things you can, and should, do to participate in your health care when you meet with your doctor. Prior to your appointment write down any questions you may have. This will help make sure that symptoms you may have been experiencing are not missed during the doctor's assessment and treatment choices. If your doctor decides that you may benefit from a new prescription, ask these three questions:
1. Is this medication available in a generic form? If not,
2. Is there another generic medication that is available that can accomplish the same things?
3. How will this new medication interact with my other current medications?
Your doctor may decide that the non-generic medication is the best for you at this time; however, it is always important to have a discussion about generics because they generally cost much less. For this reason it can be beneficial to ask about any current brand name medications that you are taking to determine if a generic is available and if your doctor believes a generic would work for you as well as the brand name.
Generic, brand medications
Identifying generic and grand name medications can be very confusing. Every medication is assigned different types of names; a brand name, a generic name, and a chemical name.
As an example, Lipitor, a common medication for high cholesterol is the brand name. The generic name for Lipitor is atorvastatin and the chemical name is (3R,5R)-7-[2-(4-fluoro-phenyl)-3-phenyl-4-(phenylcarbamoyl)-5-propan-2-ylpyrrol-1-yl]-3,5-dihydroxyheptanoic acid. Thankfully nobody uses the chemical name routinely.
The brand name of a medication is usually capitalized, as with Lipitor, and is more expensive since the company that created it had all the expense associated with research and development as well as promoting its use as a new medication. Due to these costs to create a new medication, the drug company may be awarded a patent lasting up to 20 years intended to allow them to recover the research and development costs they incurred. During this time no other drug company can offer a generic version of that new medication. Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original brand name drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts. Once the patent expires generic versions can be created by other drug companies. Generic costs are lower since the other drug companies do not have the same costs to produce them.
On the bottle from your pharmacy, the label may identify a medication you are taking by the generic name; this does not mean, however, that you are getting a generic version of the brand name medication since it may not be available. That is why it is important to ask your doctor or pharmacist if you are receiving, or can take a generic medication.
Enrollment reminder
Please mark your calendars-the Medicare Part D prescription drug plan Annual Enrollment Period has changed. Beginning in 2011, the enrollment period will begin on Oct. 15 and will end on Dec. 7. Make sure you compare the plans available for 2012 and enroll between these dates. After Dec. 7, 2011, you will not be able to switch or enroll.
David Zimmerman is consumer assistance division director at the North Dakota Insurance Department.