Article: VA program practical model for Medicare - from Suddenly Senior

From: Frank Kaiser

Sent: Wednesday, November 23, 2005

VA program practical model for Medicare

BY ROBERT KAISER

Miami Herald

Seniors are scratching their heads at this very moment, trying to decipher the new Medicare drug benefit. For many, the program is too complex and too costly. Things shouldn't be so difficult, and needn't be.

What if the federal government were to design a plan that would be easy to understand and easy on the wallet?

They might, in fact, design one very similar to the one already operating at a well-known federal institution: the Veterans Administration Health Care System.

Just like it has led in other areas -- computerized medical records and patient safety -- the VA is far ahead of the private sector in designing and administering a plan for prescription drugs for their patients.

How does the program work? The answer is: very simply.

Any veteran who is eligible to receive medical care in the national VA system is eligible to receive prescriptions. And patients don't need to drive to a VA pharmacy to have them dispensed. They can be refilled over the phone and sent in the mail.

Control of costs

How much does all this cost? For 100-percent, service-connected veterans and for those who qualify on the basis of income, the medications are free. Nonservice-connected veterans must pay only $7 per monthly prescription.

And what about the crucial objective of controlling costs? The U.S. government can use its considerable buying power to negotiate the best prices from drug companies. As the nation's largest health care system, the VA negotiates some of the lowest drug prices in the country. The new Medicare plan prohibits any such negotiation, and its estimated costs are rising.

A patient or physician should be rightly concerned about which drugs are covered under a prospective drug plan. Many of the patients cared for in the VA system, just like Medicare patients, are older and have multiple medical problems. To treat them properly, the list of available drugs must be complete. Though the VA does not offer every drug on the market, it does include a good selection, one that is determined by a committee on which physicians and pharmacists are well represented. As a VA physician, I may not be able to prescribe any drug I want, but I can prescribe every drug I need.

And if a drug on that VA list isn't effectively treating a patient's blood pressure or cholesterol or pain, a doctor may request another, ''nonformulary'' medication. Such requests are not immediately dismissed, but are given careful consideration. And, in my decade-long experience as a VA doctor, all medically reasonable requests I have made have been granted.

Any system has its flaws, and the VA system is no exception. Filling prescriptions late at night or on the weekend can be difficult. Under those circumstances, using a private pharmacy or going to a VA Emergency Room are the only real options. For patients with limited incomes, those are not optimal alternatives. Formularies are not exactly the same in each VA regional hospital network, so patients who move or travel from one region to another might require that their prescriptions be changed. For those patients who receive some care in the private sector (for example, by a specialist), their prescriptions from that physician need to be rewritten before they can be filled by a VA pharmacy. These flaws are not fatal, but currently require patience and flexibility, and ultimately demand innovative solutions.

As it now stands, the VA program is practical and worthy of envy. It can and should serve as a possible model for reengineering Medicare's beleaguered drug benefit. And perhaps all those seniors might soon stop scratching their heads in frustration.

Robert Kaiser, MD, is an associate professor of medicine at the University of Miami