Medicare Part D provides some prescription coverage

It is important for employers with group health plans to notify all Medicare-eligible employees and/or dependents about their plans and advise them to seek information and advice on what they should do about Part D before Nov. 15. There can be some hefty costs associated with not enrolling when eligible, but each circumstance could be different. The best advice is to contact the Centers for Medicare Services, www.cms.gov, or a local agency such as the Southwest Missouri Office on Aging to get answers to questions that you might have.

There is plenty happening in health care in addition to Medicare Part D. Drugs are continuing to eat 15 percent to 25 percent of the total claims for a health plan. While ingredient costs seem to increase at 5 percent to 10 percent, the overall increased usage of drugs accounts for the difference. Also we see the patient portion of the costs rising by just a small percentage. This will lead to increased costs for the plan, which means higher premiums, which means increased employer/employee costs or reductions in benefits, which cause more out-of-pocket expense for employees and their families. It is a vicious circle that, in my opinion, can only be truly changed in one of two ways. One is for the government to step in and tell the pharmaceutical companies, “Enough is enough.” Those companies are having little trouble in producing a positive bottom line. Demand is high and supply is good. However, the supply and demand business model fails in the prescription drug industry because the price is set by the manufacturer, the doctor prescribes the drug, and the insurance company pays the lion’s share of the cost. Consumers pay very little in the big picture.

The drugs are worth it when you need them, but there may be other options available in discussion with and on the advice a physician. If you have high cholesterol and the doctor prescribes Lipitor (the No. 1 prescribed drug in the United States today), you may see very good benefits from usage. However, there will no doubt be some side effects to the drug, and according to many sources, simple exercise and proper eating habits can lower cholesterol.

It’s important to have a good relationship with your personal pharmacist. That relationship should be strong enough that you can talk candidly and ask questions about different medications and treatment methods that they see or read about. If the ideas appeal to you, ask your doctor. He or she should be glad you are asking and being a part of your health care solution. Your pharmacist should be the same as well. Ask questions. Pharmacists deal with the drugs regularly, and they will know the good, the bad and the ugly of the medications. Also, pharmacists are a “checkpoint” to make sure you are not taking too many different drugs. If you see more than one doctor regularly, each may not know what you are taking and what impact that may have.

There are a lot of good pharmacies around, and the biggest issue that is generally seen is in the submission of claims. Virtually all prescription claims are processed electronically, and usually when there is a problem, it is because someone entered a number incorrectly or they used the wrong card. These problems are generally easy to fix but a hassle to deal with, and often very frustrating.

That’s just one more reason to have a good relationship with your pharmacist.

If you require ongoing medication and don’t have a regular pharmacist, I encourage you to find one. They are an important part of the health care equation and can help you make a difference in your own care.

Mike Scott is an account executive for Barker Phillips Jackson, an employee-owned independent insurance agency.

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