The Medicare Prescription, Improvement and Modernization Act of 2003 went into effect on Jan. 1, 2006, and effectively created the Medicare D prescription plan.

The first year of the program saw much confusion and guarded optimism, but it has progressed and evolved into a mainstay of Medicare with nearly 24 million individuals receiving prescription drug coverage.

Many beneficiaries initially did not understand how the program worked, particularly concerning the Coverage Gap, commonly known as the "doughnut hole." Basically after an initial coverage limit of $2,500 is reached, the beneficiary must pay the full cost of their medicine until their total reaches a little over $4,000.

The first year of the plan many did not understand the dollar amounts included total cost, patients copay plus the amount the insurance paid to the pharmacy and were surprised to reach the hole and have to pay full price.

Most participants now know what to expect and many start saving money the first of the year in anticipation of reaching the gap. Part of HCR in pharmacy is the elimination of the doughnut hole, which will increase Medicare dollars.

Even though actual expenditures have come under projected cost last year and will likely again this year, prescription medication makes up 12-15 percent of Medicare. Before Medicare D those costs were 2 percent or less.

If eliminating the gap could be done without adding to the deficit, it's a great idea. Medicare itself is an institution in this country and is here to stay. It must constantly be reassessed and evaluated to meet the needs of those entitled to benefits.

Part of the Senate HCR bill includes provisions for Medication Therapy Management (MTM), which basically pays pharmacists to help patients get the most benefit from their drug therapy by providing counseling and review of medications, in conjunction with their physician, to improve outcome and reduce adverse events. Initially this may seem like another financial burden but in effect is intended to save money.

The American Pharmaceutical Association calculated if every American with diabetes were to receive MTM services, a $23 billion savings could be realized. This provision would easily pay for itself.

No doubt the pharmacy industry would benefit from these proposals. The Medicare D plan has increased the number of prescriptions and some insurers currently pay for the MTM services. This has not been a huge windfall for pharmacies.

We still struggle with the cost of drugs and have to negotiate contracts with insurance companies, which is a whole other issue. It has allowed many to continue in a profession which provides consumers with the most available access to health care, their pharmacist.

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