Enrollment for Medicare Part D Plans Has Begun

Beginning January 1, 2005, new Medicare prescription drug plans will be available to people with Medicare. Insurance companies and other private companies will work with Medicare to off these drug plans. Medicare eligible recipients across America will be enrolling in Medicare Part D plans beginning on Tuesday, November 15, 2005 through the scheduled end of the enrollment period of May 15, 2006. If Medicare eligible recipients join these programs before December 31, 2005 their coverage will begin January 1, 2006. If they join after December 31^st then the prescription benefit will begin on the first day of the month after the month that the patient enrolled. If Medicare eligible patients do not enroll by May 15^th they will have to wait until the next enrollment period which is scheduled to begin in November each year. Patients who fail to enroll when eligible may see the premiums that they may have to pay rise by 1% each month that they are not enrolled in a Medicare Part D plan. Plans can be changed at least once each year between November 15th through December 31st of each year. Pharmacists throughout Florida have been working with patients to help them find the appropriate plan. In a meeting last week with officials from the Department of Health and Human Services FPA Executive Vice President Michael Jackson shared with Secretary Mike Leavitt efforts by Florida pharmacists to help our state’s citizens to understand the program. Jackson also reminded Secretary Leavitt how important is the need for the medication therapy management portion of Medicare Part D and that it is not enough to simply provide a benefit without proper monitoring. Secretary Leavitt was appreciative of the efforts by pharmacists and reminded others in attendance at the meeting that the Center for Medicare and Medicaid Services (CMS) will be relying heavily on pharmacists for their educational outreach efforts. A full host of tools are available for pharmacists to assist patients at www.medicare.gov.

Dual Eligible Medicaid Patients Auto Assigned to Part D Plans

Florida patients who have been eligible for both Medicaid and Medicare (dual eligible patients) have been auto assigned to one of six designated Medicare Part D plans here in Florida.  It is our understanding that Medicaid dual eligible recipients when enrolled in these plans will not have to pay a premium or meet their deductible.  These patients may be subject to a small co-pay for their prescription drugs which they may have to pay.  Their prescription drug coverage will begin in January.  It is unknown at this time whether or not any or all of the listed plans below will cover all of a dual eligible patient’s medications.  That is to be determined by the formulary for each plan.  You will have to visit www.medicare.gov and examine the published formulary for each patient that may have a question.  It is also our understanding that patients could select other plans not on the list but if they do they may be subject to the deductible or have to pay a premium.  

Dual Eligible and Silver Saver Patients Provided information on Medicare Part D

To assist dual eligible patients with their decision on which Medicare Part D prescription benefit plan to select the Agency for Health Care Administration (AHCA) is mailing customized letters to each dually eligible Medicare beneficiary with a list of plans that they may want to consider.  AHCA, through a contractor reviewed claims data and listed in each letter the plans most suitable for these patients based upon their medication history.  A sample of that letter has been provided below. A similar letter was also provided to those patients participating in the Silver Saver Prescription assistance program.  The Silver Saver program will end on December 31, 2005.

Dear Beneficiary:

Starting January 1, 2006, the federal Medicare program will cover your prescription drug costs instead of Florida Medicaid.  For your new prescription drug coverage to start on January 1, 2006, you will need to choose and join a Medicare prescription drug plan by December 31, 2005. This change will not affect other non-pharmacy, medical costs Medicaid may currently cover for you. In Florida, there are six Medicare-approved plans you may choose from that are available to you with no monthly premium and no yearly deductible. Your only cost will be the co-payments you may have for your prescriptions. The six plans are listed in the table on the following page. If you do not join the drug plan of your own choice by December 31, 2005, Medicare will automatically enroll you in one of these plans.  The state of Florida would like to help you in determining the plan that best fits your needs. To help you understand your options, we have matched the medications and pharmacies you use now with those offered by the six plans. The table on the following page lists the plans alphabetically and shows the number of medications you take, how many are covered by each plan, and the names of the pharmacies you use that are in each plan’s network. To choose one of these plans, call the number next to the plan and ask for enrollment information. Other plans may also be available (see the disclaimers on the following page). More information about the Medicare-approved plans and your Medicare prescription drug coverage is available by calling 1-800-MEDICARE (1-800-633-4227) or online at www.medicare.gov.

Sincerely,
Tom Arnold

Disclaimers:

·         The plans listed in this letter were selected based on the medication data available in the months prior to the printing of this letter.  Any change in prescription medications since that time is not factored into this information.  As such, we strongly recommend you check with the plan to verify coverage.

·         You may be responsible for a nominal co-payment for each medication you take.  Other plans are available that may offer enhanced coverage at an additional cost.  

·         If on January 1, 2006, you have been automatically enrolled, you have the right to change plans and choose another Medicare-approved plan you feel more closely meets your needs.  You are not required to stay in the plan chosen for you.

·         For pharmacists and physicians: additional information regarding medication coverage for your patients may be available by visiting www.id-health.com and selecting the “BCE” link.

·         This list of plans does not reflect the Medicare Advantage Prescription Drug plans which may also be available to you.  These HMO-based plans may offer enhanced benefits and/or reduced co-payments.

Medicare Part D Frequently Asked Questions

Many pharmacy providers across Florida are getting a host of questions from Medicare eligible recipients on the new Medicare Part D plan.  An excellent resource of frequently asked questions has been posted on the Medicare website.  A sampling of those questions is as follows:

v       What are the Medicare premiums and coinsurance rates for 2006? 

v       I qualify for extra help paying for Medicare Prescription Drug Coverage. The charts in the Medicare & You 2006 handbook say I can join any of the plans listed, and I won't have to pay a premium. Is this true? 

v       How do I join a Medicare Prescription Drug Plan? 

v       Is there someone to help me choose a Medicare prescription drug plan? 

v       Is there information and help available to compare Medicare drug plans?

v       How do I pay for the coverage? 

v       What if the prescription I take is not covered by my Medicare drug plan? Will Medicaid still pay for it?

v       Do I have to join a Medicare drug plan? 

v       What happens if I choose not to join a Medicare drug plan by May 15, 2006? 

v       Are any drug categories not included in Medicare prescription drug coverage? 

v       If I am not certain whether or not I qualify, should I apply for extra help? 

v       Is this Medicare prescription drug coverage better than what I have now? 

v       How do I know if I have “full Medicaid coverage?”

v       I have both Medicare and full Medicaid coverage. Do I need to apply for extra help to pay for Medicare prescription drug coverage? 

v       Will some drugs still be covered under Part B? 

v       What if I need a drug that isn’t on the formulary or is covered at a higher cost?

v       If my prescription drugs are now paid for by my state Medicaid program, will Medicaid still pay for drugs I take that aren’t covered by Medicare prescription drug coverage (such as sleeping pills or prescription vitamins)?

v       What if I don’t want the plan that Medicare chooses for me? 

v       What information do I need to apply for the extra help? 

v       What if Medicare doesn’t cover my prescription at all? Will Medicaid still pay for it?

Medicare Part D Secondary Payer Billing Process

TO:                         Independent Pharmacies

SUBJECT:            Automating the Medicare Part D Secondary Payer Billing Process

Prescription Drug Plans, supplemental payers and the Medicare Part D TrOOP Facilitator (NDCHealth) must interact to ensure proper coordination of benefits and to track patients’ true out-of-pocket expenses accurately.  To maximize efficiency, this process will involve primarily real-time communication of patient eligibility and insurance coverage information and claims data.  We know that many of you are already involved in efforts to address the systems requirements associated with the implementation of Medicare Part D, but we have received some inquiries and in response have assembled this information to provide assistance where needed. The FPA has received a set of PowerPoint slides containing information that will be useful to you in updating your software to automate the information exchange associated with the secondary payer billing process.  These slides do not contain the technical specifications, but rather present a general description of the transaction flow and standard message formatting that define what is required to automate the process.  For additional guidance, please refer to the NCPDP Telecommunication Standard version 5.1, NCPDP Telecommunication Standard Implementation Guide version C.1 (which contains a series of Frequently Asked Questions), and the NDCHealth website, http://medifacd.ndchealth.com/Home/MediFacD_Home.htm.   Should you require further information, please submit your questions to troopquestions@ndchealth.com. , or contact Deborah Larwood at CMS (410-786-9500). 

FPA Members Call Congress on Federal Medicaid Cuts

On Monday, November 14, 2005 Congress will continue its discussions on the House Budget Reconciliation Act H.R. 4241.  The Florida Pharmacy Association has joined a national coalition to help educate our congressional policy makers on this very important and critical issue. Pharmacy providers will see terrifying and perilous reimbursement reductions in the Medicaid program at the federal level.  Budget reductions under consideration suggest that pharmacies are making significant windfall profits at the expense of state and federal entitlement programs for the poor.  Proposals that we have seen so far may force pharmacy providers to dispense prescription medications below their costs.  Consider the following discussion points and comments from our national coalition partners:

v       Setting a federal minimum for pharmacy dispensing fees.  The Coalition for Meaningful Medicaid Reform (CMMR) believes that making Medicaid available to patients requires a fair and reasonable pharmacy reimbursement to cover the cost of the medication, the cost of dispensing and providing professional pharmacist services, and a small amount to provide a fair return to the community pharmacy that has elected to participate in the program.

v       Updating reimbursement data monthly to assure adequate payment.  Due to the constant fluctuation in price of prescription medicines, the current House plan could force pharmacies to absorb cost increases for two quarters.  CMMR asks for monthly updates to pricing guides rather than every quarter. 

“The legislation under consideration won’t work for Medicaid patients or for pharmacies,” said Bruce Roberts, R.Ph, executive vice president and CEO of the National Community Pharmacy Association.  “If this legislation is enacted, Medicaid patients could have significantly reduced access to the prescription medications that they need to maintain life and health.”

Members of CMMR cited concern for the estimated 40 million Americans who will receive Medicaid in 2006.  The group says individuals on Medicaid are often among the most underserved members of society, and anticipates that cuts to vital pharmacy services could have dire public health consequences for a wide variety of Americans.

"We are very concerned about the impact that the Medicaid cuts in the current House legislation will have on the fragile medical infrastructure of our rural communities," said Rebecca Snead, Administrative Manager of the National Council of State Pharmacy Association Executives.  "In many of these communities the local pharmacy is the only medical infrastructure left and these cuts threaten their continued viability, thereby not only impacting the Medicaid patient population, but the community as a whole."

CMMR expressed its willingness to continue to work with Congress and state governments for meaningful Medicaid reform that would secure savings and preserve the ability of people on Medicaid to receive their prescription medications.

“The members of CMMR remain committed to the shared philosophies of helping Medicaid recipients that both we and members of Congress brought to this task,” added Fuller. “While we don’t think the proposed House legislation is the right solution, we also believe that, in time, meaningful Medicaid reform can be developed.”

FPA members should have received an action alert from our legislative action center.  This web based messaging center will help you get connected with your congressman to address this issue.  Take a few minutes to visit http://capwiz.com/pharmview/state/main/?state=FL and make one of the most important calls of your career.  Your Florida congressman should not be making these decisions without your input.  If some of the proposals that we are seeing in Washington go forward patients may not have the choice of pharmacy providers that they have now.

Pharmacist Immunization Bill Filed inFlorida Senate

Florida is one of a handful of states that do not allow their pharmacists to provide immunization services.  Last year the FPA was successful in getting the Senate version of the bill passed however the Florida House of Representatives has not been convinced that this issue would be good public policy.  Senate Bill 570 has been filed by Senator Mike Bennett to allow pharmacists in Florida to administer influenza immunizations under physician protocol.  The bill has not been referenced into any committees nor is there a House version at this time.    Members are urged to speak with their state representatives and Senators and help educate them on this issue.  Help your state representatives understand that these bills do not fraction health care services rather they set in place a way for pharmacists and physicians to work together to advocate for preventative health care. States that allow pharmacists to provide these services have higher immunization rates and lower incidences of influenza than states that do not.   Pharmacists would not be required by the law to provide these services. Those who choose to do so will need to complete Board of Pharmacy approved training program, maintain liability insurance and maintain CPR certification. Employee pharmacists will also have to obtain approval from their employer.This is an important initiative as health department officials are projecting a major flu pandemic within the next few years. Florida will be one of the few states that pharmacists will not be able to assist unless these bills are found favorable.

Senate Bill 7022 Revises Licensure Transfer Regulations

In the year 2000 the Florida legislature amended 465 to allow for pharmacists in other states to transfer their licenses to Florida without having to retake the NAPLEX examination.  Since then there have been over 1,034 licenses transferred to Florida under 465.0075. The law that passed in the year 2000 required a review by the 2006 legislature.  In Senate bill 7022 changes to the licensure endorsement statutes would require an applicant for licensure as a pharmacist by endorsement who has been licensed in another state for more than 2 years before the date of application to complete the required 30 hours of continuing education within 24 months, rather than 2 calendar years, immediately preceding application.
There are currently over 22,000 Florida licensed pharmacists. Most live within the state ofFlorida. While there is no House bill at this time one is anticipated.