Patient Handouts – Medicare Part D (With No Medicaid)

As part of my “Dedication to Pharmacy”, I am going to create some patient handouts that you can give to your patients to explain things that you don’t want/have to. Whether you give these out is by your own professional judgment, HOWEVER I will not be responsible/feel bad if your patient takes his/her business elsewhere.

—— 8< CUT HERE 8< —–

Dear __________________________,

You have been given this information handout courtesy of “The Angry Pharmacist” (http://www.theangrypharmacist.com) because you are unable to understand simple spoken concepts. Your caring pharmacist:
__________________________________________________ BS PharmD (circle one)
has decided that you are not worth his her (circle one) time to explain this concept to you. They have probably explained this to you for the past 4 years, but since you are old and dense, they are unable to take the blank cow-eyes(tm) stare yet again as they waste their breath. Talking to the sky or filtering pee out of the ocean would be a less monumental task than trying to explain Medicare Part D concepts to you, so they have given you this handout so you may study it during the commercial breaks of Jag reruns.

Since January 1st (the start of the new year, the last big party you attended where people said HAPPY NEW YEAR), your deductible has reset.

***TAKE DEEP BREATH, AN EXTRA ARICEPT, AND PREPARE YOURSELF FOR SIMPLE YET SOMEHOW CONFUSING CONCEPTS***

cuteold.jpgDEDUCTIBLE (DEE-DUCT-A-BULL) is a dollar (meaning money) amount that YOU MUST PAY before your insurance kicks in. Think of it as PAYING $15 before you EAT AT HOMETOWN BUFFET. That’s right, you must PAY MONEY (COPAYS) BEFORE YOUR INSURANCE KICKS IN. Usually DEDUCTIBLES range from 200 to 300 dollars. If you have no idea what your deductible is, your pharmacist cannot help you, call the 1-800 number on the back of your card (the plastic thing with the colors and numbers on it. No, not your red-white-blue one, the other one. No, not the one from last year, THE NEW ONE YOU JUST GOT. That one!)
Remember that no matter how angry you get, and how much you ask, your pharmacist does NOT KNOW what your deductible is! We can guess; but you can also crap your pants, both of which benefit us mutually.

*** WATCH OUT! HERE COMES THE HARDEST CONCEPT OF THEM ALL! ***

DOUGHNUT HOLE (PASTRY – WHAT YOU POOP OUT OF). When you hit a set dollar amount, your insurance cuts out until you have reached another dollar amount, then it kicks back in.

Using made up IMAGINARY/MADE UP NUMBERS lets see how this works:

  1. January 1st hits (Remember? Happy new year? Party?)
  2. You pay $250 IN COPAYS to get your insurance to work (DEDUCTIBLE).
  3. You can get drugs FOR ALMOST FREE until the cost of the drugs (NOT YOUR COPAYS) hits $2400
  4. Your insurance CUTS OFF AND YOU PAY EVERYTHING until the cost of the drugs (NOT YOUR COPAYS) hits $5100.
  5. Blame the pharmacist and the world for taking food out of your mouth because you are on a fixed income.
  6. Once you hit over $5100 in DRUG COSTS (NOT YOUR COPAYS), Your insurance MAGICALLY RETURNS LIKE JAG and pays ALMOST EVERYTHING!!!!!!!! until the end of the year. Break out the Geritol and Viagra!

Your pharmacist will circle where you are in this easy-to follow chart!

Stolen from Wikipedia (the new thing all the kids are doing now days)
http://en.wikipedia.org/wiki/Donut_Hole_(Medicare)
Total Drug Spend TrOOP Out of Pocket Cost Portion Covered by Medicare
$0-$250 $0-$250 Deductible is out-of-pocket No Medicare Coverage of Costs
$250-$2,250 $250-$750 25% out-of-pocket 75% Covered by Medicare
$2,250-5,100 $750-$3600 All costs are out-of-pocket No Medicare Coverage of Costs
over $5,100 over $3600 5% out-of-pocket 95% Covered by Medicare
Note: In 2007 the $2250 amount was changed to $2400 and the $3600 became $3850.

** OH NO! CONFUSING WORDS! **

The TrOOP above stands for True Out Of Pocket (Get it?) cost. That is YOUR COPAYS!

  • Total Drug Spend = How much the medication costs if you were to pay cash like only chumps and idiots do
  • TrOOP = Your COPAYS. The TRUE Out of Pocket. What you pay the nice pharmacist to pick up your medication! Cue Fixed Income/I cant afford $1.10/whining and bitching.

grandpa_pear.jpgREMEMBER (hahahaha), The pharmacist is here to make sure that YOU DON’T DIE FROM MEDICINE (*sigh*), not FIX YOUR INSURANCE. That is YOUR JOB because you decided to listen to the nice salesman who lied to you and got your plan all messed up instead of your nice pharmacist who TOLD YOU TO STAY WITH YOUR CURRENT PLAN. Remember that? Of course you don’t.

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24 Comments

  1. San Diego loves TAP says:

    This is one of your best, an instant classic. Hilarious.

  2. Nina Abb says:

    You are hilarious! I couldn’t have explained it better myself. Hahaha

  3. Meredith B. says:

    I work for a Part D plan, in customer service, so when they call the number on the back of their pretty card, they talk to me. I also worked as a tech in retail a couple years back, so I’m aware of the pain at both ends.
    The only thing I want to comment about is where you said they leave the gap when their TDS reaches the upper limit. Is it different in your state? Because in all the plans I’ve ever worked with or researched (I’m in the Midwest), the gap ends when the TRooP reaches the upper limit, NOT the TDS.
    We have a lot of people who call, thinking they’ve hit the gap at $2700 and will leave when they’ve paid another $1650. Not so; say at TDS of $2700 they’ve paid $1000 and the plan has paid $1700? They still have to spend $3350 before reaching the gap.
    Like I said, I just wondered if there are Part D plans that work another way.

  4. libertarienne says:

    Wow, LOL I think I just peed my self a little. I love the form. Very thorough…the only thing you left out was the GINORMOUS TYPE you’d have to put it in for Mr./Mrs. Greatest Generation to be able to read it.
    My mother took phone calls for Wellpoint and hated it. People would bitch and moan about not getting their Viagra “for their heart!” (because it wasn’t from a cardiologist) and she said people bitched about not being able to get their benzos and barbies cause it wasn’t covered for some reason.
    Also, having to hear people sob to you on the phone when they’ve hit the doughnut hole and have no way to pay for their meds drained her soul a little. Some people would threaten suicide, as if she was able to magically wave her Medicare wand and make it go away. It was a horrid job. :(

  5. http://openid.aol.com/tamzidy says:

    hahah the images just make this more real 😀

  6. pharmTech says:

    This has to be the funniest frickin thing ever!!! I especially like the end about the salesmans lies and the fact that we told them to stay with the plan they had…I don’t know how many phone calls I had to make because they screwed their plans up trying to find a company whos co-pays were less than $1.10. i am giving a huge KUDOS to you! keep up the kick ass work!!!

  7. Rxtech says:

    lmao. wow Love this entry. Seriously how they act and how i feel. Really thinking about printing it and giving it out to the old farts

  8. The CookieMaker says:

    oh man I work for one of the insurance companies and I have to say that is brilliant. I wish I could mail that out to some of the people who call me saying things like; “but I paid my deductible last year,” or “but I pay a premium why do I have to pay a copay? why don’t you take it out of the 2400? I don’t understand.”
    Us at the insurance company have it nice compared to you at the pharmacy. after 15 to 20 minutes they tell us they are going to call their lawyer, congress, Obama, etc and then hang up. if they call back they are just going to get some other heather who is going to happily re-explain it to them. however if they go back to the pharmacy they are just going to get you. you are of course going to get even more upset because you just got through explaining it to them not ten minutes ago.

  9. I hate Medicare says:

    I cannot count the number of people that talked to some sales man and signed up for a certain plan that included their Part D, and the supplemental insurance. I will not name the company for fear of some sort of retribution from some contract I may or may not have signed with them, but These people signed up for this plan, paid them lots of money and then were enrolled in just the supplemental portion of the plan and not the Part D portion. Then the company has the audacity to say OOPS! We screwed up, we will re-enroll you, but you will have to wait until next month for it to be active!
    I have had everyone fix it, but I still have 2 people that won’t fix it, they just keep coming in asking if it is working yet. I give them the exact numbers to call to fix it etc, but it does not work. They expect me to call and fix it. I try to explain to them that they have to fix it, but one guy is 92 and the other is 88…they just don’t understand, and they tell me that some guy came in, told them it was a great plan and told him that they would take care of everything!
    I also have about a half dozen patients that took crazy expensive stuff (yeah dual-eligible peeps) and I had done all the PAs for them–Celebrex, Oxycontin, Duragesic, Nexium (BID), etc. All renewed in October/November…Then they decided to switch plans and we have to do them allll over again! One company would not approve Oxycontin, so we had to order in a crap load of Avinza…Also they dont cover Nitro patches anymore, but they will cover brand NItro-Dur….So my patient either pays a $35 copay/$98 in the Donut hole, or I charget them $29 cash…hmmm I wonder what they want to do!….I hate Medicare

  10. fazzizle says:

    mr. druggist could you explain please what this paper is about?

  11. AZ_RPh says:

    Pure gold! …if I wasn’t such an upstanding member of the pharmacy community, I’d be tempted to print some out and go leave them in my competitors’ waiting rooms! lol

  12. intern2010 says:

    I could use part of that just to explain how any insurance bar medicaid works to some people who come into the pharmacy. I hate spending 20 minutes trying to explain why the copay is coming back as 30 dollars when they claim their copay is $5 for everything. Of course then they pull out their card and actually look at it and decide that they do have a deductible or a tier copay and probably the drug is a tier 2 or 3 and therefore that’s why they are paying more.

  13. the misunderstood profession says:

    This is priceless. I almost spit my yogurt all over my workstation. I have to show my former retail partner this post. Makes me want to print this out for my family, too, to get a “GO TA HELL” from my dad and a scowl from my aunts.

  14. http://openid.aol.com/mrahul says:

    What do you think about retail pharmacy verses Mail order pharmacy, which is better?

  15. chris says:

    This i quite interesting, I have never worked in the USA and here things like doughnut hole, co-pay etc bandied about. This explains it to me. I I have sympathy for you all, I can imagine the crap I’d have to go through explaining this to some of my patients.

  16. S says:

    I work in the appeal and grievance portion of a medicare part d company, and I tell ya, trying to get the old farts (and the young lazy asses) to understand the plans are not fun at all.
    Coverage Gap?
    TrOOP?
    Catastrophic Coverage?
    Benzos, Barbs, and ED drugs?
    Actiq for anything BUT cancer?
    What do you mean this drugs not FDA approved???
    I tell ya, I’ve been cussed out, threatened, belittled, ect, lol.
    But, this handout would be a crackup to give out to the idiots.
    S

  17. employed loser says:

    hey TAP, funny medicare info and cute pics too!
    however i feel that i may be the next aricept patient coming to a big drug “infomercial” soo i just wanted to tell you and all the pharm folks fuck u. no just kidding love the sight but i still would like to hear MORE of your funny ass vicodin soma cracks, their good. also i have a link that may interest you and your fellow pharma folks. its hilarious too. if our money wouldnt pay for it. so heres the link and keep on ranting.
    http://community.livejournal.com/vicodinwhore/

  18. Aimee Joy says:

    I love you now MORE than ever. I think. ;-0

  19. Was that a picture of John McCain?
    Wow… he really IS that old!

  20. ihatepatients says:

    I am printing this out and bringing it to work tomorrow.

  21. RxTech808 says:

    Awesome as always TAP!
    I printed this out and shared this with my pharmacy staff. Needless to say, it definitely brightened up our Monday from hell. =)

  22. hard working rph says:

    TAP, can we have some more rants about stinky and welfare patients? im quite partial of those also more stories about vicodin addicts getting busted by you.

  23. jenna says:

    this made my morning!! After spending 8 hours with these people last night..it made me laugh, which was MUCH NEEDED! Thanks!!!

  24. Kev says:

    I stumbled onto this thread while researching Medicare Part D stuff for a potential employer – long story. What a mess! I put complex IT solutions together for Fortune 500 companies, and this would drive me to drink. I can’t imagine how difficult it must be for Pharmacists and their staff to deal with the number of questions they must receive every day on the subject. Unfortunately you are the face to the consumer, and you seem to pay a price for it. I could see myself struggling with the load and burden as I see many of you are.

    What disturbs me is the disrespectful and dishonoring way the elderly are spoken of in the letter and in the postings. Some may say it is all in fun, but the angst is clear and significant. A society will be remembered by how it treats their weaker members, and these posts have opened my eyes to the contempt that is felt by many in your profession concerning the precious people who have gone before us and have sacrificed so much to make a better life for those behind.

    The marginalization of the weak, especially the elderly, is at the root of the very problem that everyone seems to be complaining about in the posts. Consider this – if the elderly were respected and appropriately honored, then:

    1. Societies would look for ways to improve quality of life for them.
    2. Businesses would seek to find ways to support this endeavor including bringing sanity to insurance and health plans.
    3. And pharmacists would have the opportunity and privilege to stand in the gap for their elderly customers – finding ways to help them understand while being an advocate, rather than a disgruntled and disrespectful critic.

    I know it is hard, but the high road always is. And it won’t get any better until we all get a little more “out of ourselves” and think a bit more about others – something I struggle with a lot.

    I hope this is received in the way it was intended – as an encouragement.

    Kev – age 53 – but act like I am 30.

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