Via The Sideshow..Why Medicare Part D is not working....Medicare Analogies by Ezra Klein

As an enrollee in Medicare part D I would agree with Ezra's car analogy. However, I would take exception to the facet that enrollee satisfaction is high because of for some road blocks that the legislation has written in it that has affected me recently.The legislation has some qualifiers, in fine black print, which affects getting certain medications in a cost effective and timely manner. As an example: I recently went to my Physician's Assistant to try and get more migraine pills to last a month as the 6 I am allotted is not enough for me. While I was there, I also got a prescription for Zyrtec, an effective allergy medicine that I have had success with in the past. Since I am now living in the grass seed capital of the world (the Willamette Valley) allergies and its related symptoms have been a problem. My prescription for migraine pills went through and I now get 9 pills a month which shall help me get through a month in less pain, however, Zyretec will only be covered once and then I must try other drugs on their formulary first as part of a step therapy program. The way I interpret this rule is that I need to try other medications first which involves another doctor appointment and a $10 co-payment. If this medication is not effective I step to another drug that is on their formulary and so on and so forth until I reach a winning combination. This process is time consuming and could postpone well being for months. Not everyone can get in to see their doctor within one or two weeks of making an appointment. Another option is to get over the counter Claritin and pay a lot more for effective treatment myself and not even go to a doctor or physician's assistant. My insurance company explains that I can request a formulary exception if none of the drugs on their formulary is medically appropriate for treating my condition. There are mechanisms to request exceptions when a medication is denied but I have yet to "experiment" with that route yet.

So< yes Medicare Part D does work but it has restrictions that do not promote ideal health. There are still hoops to jump through even with drugs on their formulary. The insurance copanies can opt for cheaper medications for its enrollees and it takes time and a fair amount of frustration to get health problems resolved.