New prescription drug card: It's enough to make you sick

When I saw a Wall Street Journal article describing the Medicare Web site that would enable seniors to select the most beneficial discount drug card, I thought I would step in and help my parents.
The full Medicare prescription drug coverage program does not begin until Jan. 1, 2006. The discount drug program was designed to give Medicare enrollees a discount on prescription medications before that date. These cards would be approved by Medicare, but sponsored by pharmaceutical companies, traditional health insurers and various other groups.
For example, Aetna sponsors a card, as does AARP. There are more than 70 groups that offer these discount cards. In exchange for the volume of patients who will sign up for a particular card, the companies are able to offer a discount in price. Most have modest enrollment fees of $20 to $30.
In my case
Both my parents have Medicare, and my mother, a retired registered nurse, is computer savvy. But I am a physician and have a master's degree in health-care statistical analyses, so I thought I could go through the choices most efficiently.
Four days later I was still sufficiently frazzled by the experience that I was thinking of sending my parents to Canada for adoption.
I traveled home to Ohio for Mother's Day weekend to visit my parents, Vince and Dorothy Bernard of Liberty Township. On Saturday morning, I was confident that I could whip through a Medicare Web site in a few minutes and have plenty of time for breakfast. I was wrong. Before I was finished, I used up the better part of six hours, a ream of paper and the skills of my brother, Louis, a tax attorney who lives in Virginia. I also missed breakfast.
I had believed the Democrats were wrong in opposing the drug card. They still were yearning for a national health insurance program, which would never happen. I had come to believe that a market-based system would provide incentives for efficiency, innovation and personal responsibility.
That was before.
I sat down at my mom's computer and found the Web site. No problem. I began to answer a few short questions.
An odd instruction popped up: List your drugs to determine whether a card covers your prescriptions.
What? A company could offer an approved Medicare card, but decline to cover certain drugs?
Assuming a company is responsive to its shareholders, that company would exclude from coverage the least profitable drugs. Least profitable could translate to more unique, more expensive medications. What happens if a physician prescribes a drug not on a card's list in the coming year? OK, some market-based problems.
I was sure Health and Human Services Director Tommy Thompson had answers.
Good thing my parents had me look through their drugs. I could find generic equivalents (cheaper) for their prescriptions. But both of my parents were on medications with no generic equivalents. I plugged in my parents' drug list without changes. Finding a card that covered all of my parents' drugs in their area whittled down my choices from 73 to about 40.
Not bad. Should have been pretty easy from there. Except there was another obstacle. I had to find pharmacies in the area that supply the drugs and accept the cards. I plugged in that criterion and the list shrank to about 25.
OK, 25 choices. I would just create a matrix with the costs of both my parents' drugs at the local pharmacies, and see which pharmacy is the least expensive. But I wanted to see the costs of both 30-day and 90-day supplies. Ninety-day mail order supplies usually are cheaper.
Fewer and fewer
Not all the cards have 90-day supplies. That eliminated 10 or so. I assume that the relative costs among cards are probably similar. Not so. The 30- and 90-day costs bore almost no relationship to each other. If my parents were to opt for the cheapest 30-day costs, the 90-day cost would be high. I will develop a quadratic equation. Fortunately, at this point my brother arrived. He proceeded to develop a table with both 30- and 90-day costs, for each of my parents separately and together, for about 15 cards that meet all of our criteria. (While my brother did this I ate lunch). Looking at the table, we decided on five cards with reasonable 30-day costs, but lower 90-day costs.
Conscious of market forces, I also decided on another criterion: that the card should have more than one 90-day supplier (by this time, I was suspicious that at least some of these cards or the pharmacies that accept them may go bankrupt after the initial party is over). That brought us down to three cards. It was now about 3:30 p.m. and we were all late for my nephew's baseball game. We decided to break for the day.
After review
On Sunday, I reviewed the results with my parents and told them which cards I thought would work for them.
I worried, though, about all the seniors who will be befuddled and overwhelmed by the new program. I worried about my patients. At least my parents have children who can figure this thing out.
Wait! That was it. I could offer my services to elderly Americans, for a fee. That is the way this was supposed to work, market-based and all that.
Then I realized that a substantial portion of my time now will be taken up trying to manipulate my patients' drug regimens so that at least some of their prescriptions will be covered. I wouldn't have time to enrich myself off of this scheme. Pity. For a brief second I thought I had it all figured out.
XDr. Annette Bernard is a native of Liberty Township and a graduate of Liberty High School, Youngstown State University and the Northeast Ohio Universities College of Medicine. She practices in Atlanta and wrote this for the Journal-Constitution. In addition to her brother, she has a sister, Elizabeth, also an attorney, who lives in Canfield.