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What can pharmacists’ do about the Medicare Part D Donut hole and reimbursement? A six-state survey

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Abstract

Background

While Medicare Part D was signed into law in 2003 and initiated in 2006, there is a scarcity of information related to the implications of Part D on community pharmacies and subsequent effects.

Objective

To determine the financial implications of Part D on community pharmacy, to identify pharmacists’ and beneficiaries concerns from the pharmacists’ perspective and to determine the pharmacists’ responses to these impactions and concerns.

Methods

A cross-sectional survey of pharmacists practicing in six states (Maine, New Jersey, New York, Maryland, Massachusetts and Pennsylvania) was conducted online between June and December 2011. The 37-question online survey collected demographic data, data about implications of Part D on community pharmacy and patients, and pharmacists’ beliefs about ideal pharmacy practice and Part D plans.

Results

Of the 4,888 online surveys, only 1,108 were assumed to have reached the intended recipients (response rate 25 %). Fifty-six percent reported that reimbursement was the most significant concern, and 34.5 % of the owners or part-owners were planning to close their pharmacy due to financial pressures exerted by Part D. A significant relationship was observed between dispensing of 90 days’ supply of medications and better financial performance (χ 2 = 6.95, p = 0.0084). The most significant patient concerns were formulary and copayment (52.8 %) and Donut hole (52.4 %). Fifty-four percent respondents stated that his/her pharmacy helped patients obtain financial assistance while patients were in the Donut hole.

Conclusion

Respondents were most concerned about the poor reimbursement rates, but pharmacists who dispensed 90 day supply of medications reported acceptable financial performance. Pharmacists also reported helping patients obtain financial assistance while in the Donut hole.

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Acknowledgments

The author, Shamima Khan, MBA, PhD, would like to thank Bernard Sorofman, PhD, Professor and Executive Associate Dean, College of Pharmacy, The University of Iowa, Iowa City, Iowa, for providing his input and feedback during the survey development phase. The author would also like to thank Dr. Joshua Spooner, Assistant Dean, Student Affairs, at Western New England University for providing his guidance during manuscript preparation phase and reviewing a draft of this article. This study was funded by St. John’s University, 8000 Utopia Parkway, Queens, New York 11439. For manuscript development, Western New England University (WNE) Springfield, MA, provided in-kind contribution by offering Dr. Shamima Khan with ample time and other resources to conduct the data and statistical analyses and prepare the manuscript.

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Authors and Affiliations

  1. Department of Pharmaceutical and Administrative Sciences, College of Pharmacy, Western New England University, 1215 Wilbraham Road, Springfield, MA, 01119-2684, USA

    Shamima Khan

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  1. Shamima Khan
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Correspondence to Shamima Khan.

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Khan, S. What can pharmacists’ do about the Medicare Part D Donut hole and reimbursement? A six-state survey. Aging Clin Exp Res 27, 373–381 (2015). https://doi.org/10.1007/s40520-014-0275-2

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