Part D Helpful Hints for New Plan Year
Open enrollment for the Medicare Prescription Drug Benefit (Part D) began November 15 and ends December 31 for the 2008 plan year. This means that some patients will switch plans and perhaps have drug coverage that is different from last year's (see Original article: Part D Hassles Driving Treatment Decisions).
For Medicare Advantage plans only, beneficiaries can make one change in enrollment—enrolling in a new plan, changing plans, or canceling a plan—between January 1, 2008, and March 31, 2008.
Each Medicare drug plan is different. CMS has created a Web site at<www.medicare.gov> to ease the burden of plan comparison shopping. At this site, beneficiaries can compare plans, check formularies, and get monthly premium and prescription drug costs. They can also call (800) MEDICARE for this information; TTY users should call (877) 486-2048.
Important information about special enrollment periods, coverage in the gap or “donut hole,” low-income subsidies, enrollment, dual-eligible enrollees, and appeals is posted on the APA-sponsored site<www.mentalhealthpartd.org> and at<www.medicare.gov>.
In the meantime, here are a few Part D issues that psychiatrists should consider when trying to help their patients choose a drug plan:
Coverage: Check to see if the plan covers patients' prescription drugs. In addition to the information available online on the CMS Formulary Finder, each plan is required to publish (in print and online) its formulary. Here you should be able to find whether drugs you have prescribed require prior authorization, have quantity limits, or involve step therapy. In some cases you may have to go through the exceptions and appeals process to allow your patient to stay on medications you have been prescribing. Checking in advance may prevent prescription delays at the pharmacy come January 1. | |||||
Cost: Check to see how much prescription drugs cost in each plan. Monthly premiums, deductibles, and copayments and/or coinsurance vary among plans. | |||||
Convenience: Make sure the plan's pharmacies include the ones your patients use. In addition, some plans also allow mail-order prescriptions. | |||||
APA's Office of Healthcare Systems and Financing urges psychiatrists who experience problems with Part D—including enrollment of patients, transition from other plans, continuity of care, and appeals processes—to report them by e-mail to [email protected] or by phone at (800) 343-4671.
