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Promoting Access and Reducing Expected Out-of-Pocket Prescription Drug Costs for Vulnerable Medicare Beneficiaries: A Pharmacist-directed Model

Cutler, Timothy W. PharmD*; Stebbins, Marilyn R. PharmD*; Smith, Amanda R. MPH*; Patel, Rajul A. PharmD, PhD; Lipton, Helene L. PhD*,‡

doi: 10.1097/MLR.0b013e318202a9f2
Brief Report

Background The Medicare Part D benefit is complicated and may be costly, especially for vulnerable low-income populations where lack of resources and limited English proficiency may be barriers to optimal plan selection.

Objectives To identify vulnerable Medicare beneficiaries and lower their expected annual out-of-pocket (OOP) prescription drug costs through one-on-one prescription drug plan counseling by pharmacists and trained pharmacy students.

Research Design Between October 2008 and January 2010, a cross-sectional study was performed throughout California. Using Medicare's Prescription Drug Plan Finder tool, expected annual OOP costs for each beneficiary's current prescription drug plan were compared with the lowest-cost plan.

Subjects The study sample included vulnerable Medicare beneficiaries with annual incomes ≤300% of the Federal Poverty Level.

Results There were 1300 vulnerable beneficiaries who received counseling at 94 outreach events. Only 29% of beneficiaries with a stand-alone Part D prescription drug plan were enrolled in the lowest-cost plan. On the basis of counseling recommendations, 390 beneficiaries changed to the lowest-cost Part D plan on site, reducing their expected OOP costs by 68%. Additionally, 72 beneficiaries were identified as eligible for but not receiving low-income subsidy benefits and 55 received assistance with the online application for the subsidy.

Conclusions Findings show that targeted outreach by trained pharmacy advocates can identify vulnerable Medicare populations in need of Part D counseling and reduce their expected annual OOP prescription drug costs.

*Department of Clinical Pharmacy, School of Pharmacy, University of California—San Francisco, San Francisco, CA

Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA

Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California—San Francisco, San Francisco, CA

Supported by the Amgen Foundation.

Reprints: Timothy W. Cutler, PharmD, School of Pharmacy, University of California, San Francisco, C-152, Box 0622, 521 Parnassus Ave, San Francisco, CA 94143. e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.