Medicare Part D begins: specialty pharmacies not worried

Sunday, January 1, 2006

YARMOUTH, Maine - The New Year ushers in the start of Medicare Part D, and confusion lingers for seniors and their families, as well as physicians and pharmacists. But while beneficiaries are poring over plans and paperwork, many specialty pharmacists say changes to their neb-med business should be minimal.

Inhalation drugs delivered through a metered dose inhaler will be covered under Medicare Part D, leading to speculation that some patients could switch from aerosol therapy to the less expensive MDIs. But most providers are not concerned that a floodgate of new pharmacies will divert their neb-med patients.

“The specialty pharmacies today were able to overcome barriers and hurdles to be a Part B provider,” said Wayne Vega, a consultant to New Iberia, La.-based Acadiana Plastics. “I don't think those hurdles are going to be any easier for a new entry into the marketplace.”

With MDIs eligible for reimbursement, some patients could switch therapies to save money.

“The concern would be if physicians, for some reason, started to provide metered dose inhalers to oxygen patients instead of medication received via nebulizers; that would cut into market potential,” said Bill Bonello, an analyst with Wachovia in Minneapolis.

Cost isn't the only consideration for patients, who may be reluctant to switch therapies or pharmacies.

“There are some patients who do very well on MDIs as a replacement for aerosol therapy, but that tends to be related to their ability to perform the technique and the therapy,” said Joe Lewarski, vice president of clinical and government affairs for Inogen. “The clinical community isn't quite convinced that's going to happen.”

With monthly premiums, copays and an annual deductible, the high-utilization drug patient will derive the greatest benefit, say industry sources.

“We feel that Part D will be very profitable for our providers,” said Mickey Letson, president of Letco Companies in Decatur, Ala. “If you're a smart pharmacy, you're now going to take advantage of maintenance drugs for all your other respiratory patients.”