New Medicare Gap Coverage Discount Program from CMS

One of the main provisions of the Affordable Care Act that kicked off on the first of January when Medicare recipients who received Part D but do not benefit from the low-income grant “Extra Help” started to receive a discount of 50% under the Medicare Coverage Gap Discount Program with the purchase of applicable drugs. Seniors benefiting from Medicare also were granted a 7% bump up in coverage for all additionally covered Part D drugs when they are in the gap.

Many pharmacies are doing the following to ready themselves for this new program:

• Supply Chain Management – It is a good idea for pharmacies to review the labeler codes from the list on the CMS website with contractors from Part D to figure out if the drugs that are inventoried there are applicable.

• Staff Education - Employees of the pharmacy need to be ready to answer questions and discuss the program with patients, so staff education should be one of the first things to consider.

Benefits for covered drugs will be augmented over the next 10 years, in which case, seniors who have Medicare end up paying less in the coverage gap. It is the plan that by 2020, this gap will have closed and eligible seniors will be paying just 25% for their covered drugs up until they meet their out-of-pocket maximum.

Pharmacists Support Pulling Darvon and Darvocet from the U.S. Market.

On November 19, 2010, the U.S. Food and Drug Administration announced it is pulling the prescription painkillers Darvon and Darvocet off the U.S. market. They state there is new scientific evidence that the main ingredient of both, propoxyphene, can cause heart damage or even fatal cardiac arrest.

These drugs are manufactured by Xanadyne Pharmaceauticals, Inc. or Newport, KY. The company has agreed to withdraw the two brand-name drugs. The agency currently is asking manufactures of generic propoxyphene to do the same.

Although this is a new official announcement, many pharmacies and pharmacists pulled these two drugs several years ago. Skaggs Community Health Center stated their pharmacy stopped stocking these drugs for hospital patients as far back as 2007. Ozark-based Family Pharmacy, said the chain stopped recommending Darvon and Darvocet for the nursing home patient their business works with because of the side effects these drugs have in the elderly.

Propoxyphene is an opiod painkiller that was first sold in 1957 as Darvon. Darvocet is a combination of the drug and acetaminophen. In recent years however it has become more apparent, although this was kind of the original “weak” narcotic originally used for pain management, its effectiveness in reducing pain is no longer enough to outweigh the drug’s potential risk to the heart.

St. John’s Drug Information Center list possible alternatives for these two drugs. These alternatives include other opiods such as morphine, codeine, hydrocodone, oxycodone and tramadol, and nostreoidal, anti-inflammatory drugs such as Advil, Aleve, Cataflam and Celebrex. These drugs also have potential side effects. Codeine and other narcotics besides the risk for addiction can cause constipation; aspirin can cause bleeding in the stomach and intestines; acetaminophen can cause liver damage; ibuprofen can damage the kidneys and some NSAIDS can cause blood clots that are dangerous to the heart.

Public Citizen, a Washington-based consumer watchdog group, estimated that anywhere from 1,000 to 2,000 people have died in the United States from using propoxyphene since it was banned in the U.K. This information is based in part on data received from the state of Florida that found 395 deaths from 2005 to 2009 associated with proxoyphene. The upside is the cardiac changes that can occur while taking these drugs isn’t cumulative and that once a patient stops taking propoxyphene the risk goes away.