Pharmacists graduate from SHINE program
Angela Medeiros, PharmD, pharmacy operations manager for Cape Cod Healthcare’s Community Pharmacies decided she wanted to help patients better understand their drug coverage under Part D of Medicare, especially when they fall into the so-called “donut hole” of Medicare coverage where people have to pay out of pocket for their medications.
She also enlisted her boss, Peter Scarafile, RPh, MS, director of Cape Cod Healthcare Pharmacies to join her in the learning experience.
They enrolled in the Serving the Health Insurance Needs of Everyone, (SHINE) 12-week course and recently graduated from the program.
When Medeiros presented the idea to Scarafile, he looked over the schedule and asked her which five-hour course he should choose.
“Turns out it’s 12 sessions, five hours each, for a total of 60 hours,” said Scarafile. He looks back on it now and says “it’s a wonderful service.”
SHINE is a state program that provides free Medicare health insurance counseling, information, and assistance to any resident of Massachusetts according to the Executive Office of Elder Affairs. Volunteers can take the course to become trained counselors and certified in Medicare and Medicaid insurance programs.
“I think it is going to be a great help to patients (that Medeiros and Scarafile have taken the course), said Sheila Curtis, SHINE regional program manager. “The insurances can be so confusing.”
The Donut Hole
The Part D “donut hole” is a coverage gap in most Medicare drug plans, according to Medicare. It can be very costly to seniors when they hit the coverage gap portion of the part D drug insurance plan.
The gap begins when the member and their insurance company have paid a total of $3,700 on covered drugs, starting from January 1 each year.
From that point going forward, the member has to pay 40 percent of the cost for their brand-name drugs and 51 percent for generic drugs. Once they have paid $4,950 out-of-pocket for covered medications for that year, they have reached catastrophic coverage, which drops the costs of their medications, significantly.
Members at that point will pay either a 5 percent coinsurance for covered drugs or a co-pay of $3.30 for covered generic drugs and $8.25 for covered brand-name drugs, whichever is greater.
There are plans to help ease the burden of the coverage gap and some patients may be eligible for those programs. SHINE volunteers, the Cape Cod and Falmouth Hospital financial counselors can also help to provide this information.
Helping Patients Stay Out of the Donut Hole
“Most patients don’t know what they have for a drug insurance plan,” said Medeiros. “Some of them come to the hospital with these huge co-pays and fall into the donut hole. I didn’t really know what questions to ask or where to send them for help, but now I do.”
One of the advantages pharmacists have is that they can make suggestions for medication changes, said Scarafile.
“Our goal is to help our patients and save them money,” he said. “If a patient is taking a medication that costs $1,500 and we know of a similar drug that costs $80, and is the therapeutic equivalent to what they are taking, we can recommend the change. It will cost them less and keep them out of the donut hole.”
Both pharmacists have already seen how much the combination of their knowledge as pharmacists and their new-found awareness about Medicare insurance coverage has helped their patients and others.
“It’s a valuable service,” said Scarafile. “I was in the new retail pharmacy at Falmouth Hospital stocking shelves when a volunteer stopped by. She wanted to transfer her prescriptions and she needed help with finding out about insurance coverage. I was able to tell her how to transfer the prescriptions and show her how to go on the website to get the information about insurance.”
Seniors who are on Medicare and supplementary insurances, including a drug plan, have many guidelines to follow and also need to know the enrollment periods every year. While they are able to go to Council on Aging senior centers in their towns to sign up to meet with a SHINE counselor, there is an overwhelming demand especially during enrollment periods, noted Scarafile.
“They are looking for additional sites to the senior centers and Angela came up with the idea that it would helpful to provide the service at Stoneman Outpatient Center in Sandwich,” he said.
The pharmacists will help with some of the counseling at Stoneman and other volunteers from their class have already volunteered to help, as well.