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

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 = 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. [ABSTRACT FROM AUTHOR]