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Patient Education Vital for Improved Medicare Access, Say Panelists

Surabhi Dangi-Garimella, PhD
Experts from healthcare policy organizations and advocacy groups that cater to Medicare enrollees exchanged best practices and proposed policies to help alleviate access issues during the Cost-Sharing Roundtable, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®, on February 23, 2018, at the Barbara Jordan Conference Center in Washington, DC.
What are the current and future needs of the Medicare population to ensure continued access to care? Panelists grappled with this question at the Cost-Sharing Roundtable, co-hosted by the Patient Access Network (PAN) Foundation and The American Journal of Managed Care®, on February 23, 2018, at the Barbara Jordan Conference Center in Washington, DC. The experts weighing in to the discussion were Leigh Purvis, director, Health Services Research, AARP Public Policy Institute; Julie Carter, federal policy associate, Medicare Rights Center; Leslie Fried, JD, senior director, Center for Benefits Access, National Council on Aging; and Paul Billings, national senior vice president, Advocacy, American Lung Association.

Moderator Cliff Goodman, PhD, senior vice president and director, Center for Comparative Effectiveness Research, The Lewin Group, asked how the change in the administration had affected healthcare trends and what indicators were in use by organizations to monitor the impact on the ground.

Carter said that increased drug prices and challenges with navigating the healthcare system, among others, seemed to be on the rise. These, she added, are more practical indicators of trend. “The last 12 months have been very disruptive for patients, especially those enrolled in Medicare. This can potentially lead to a healthcare paralysis as patients struggle to make decisions.”

Coinsurance tiers increase the out-of-pocket (OOP) costs for enrollees, Fried said. “We see a significant increase in cost of drugs through the year, which results in having greater OOP at the point of sale. However, Medicare beneficiaries don’t really get the benefit at point of sale,” which results in unaffordable OOP costs, she added.

Purvis underscored the significant cost burden of growing OOP costs on Medicare beneficiaries, who have a median income of $26,000, and one-fourth of these idividuals have an average income of $15,000.

“Our members are increasingly falling through the cracks,” Purvis said. “It’s harder for me to point them in a direction and also provide help.”

Billings explained that his organization is seeing patients hit the Medicare Part D donut hole and they didn't even know it existed. He narrated the story of a patient whose $42 co-pay in the pharmacy went up to $137 when she hit the donut hole. That was a significant and unaffordable jump in her cost share, which needed additional co-pay assistance.

Organizations are trying to structure their systems so they can counsel and navigate these patients in the right direction. “We receive calls on our helpline, where we have counselors to navigate appeals and complaints, in parallel with educational programs. Often, we have a patient who may not be eligible for a program. We don’t have a mechanism to help patients who may be making just a little more than the level set for eligibility. They aren’t making a lot of money, but don’t qualify for Medicaid,” Carter explained.

She said that the Medicare Rights Center helps such patients with their appeals process and also ask them to speak to their provider about formulary tiers.

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