MEDICARE D UPDATES

Though not news by now, the roll-out of Medicare D was far from uneventful. As noted in the accompanying article, MGH Patient Financial Services is taking primary responsibility for educating MGH patients about Medicare D. The CRC of course will still also be available to assist social service staff as needed. A couple of tips:

• All Medicare D plans are required to have a “transition” plan for new enrollees. They will vary from plan to plan, but at minimum should provide for some coverage of current medications to allow time for the patient’s physician to consider alternative medications or to seek an exemption for the patient.
• For those with Medicare and coverage from the state of Massachusetts (MassHealth or Prescription Advantage), Massachusetts pharmacies have been informed that if they cannot get the information they need to verify a client’s coverage that the patient should not be turned away, and as a last resort they may bill the state for that prescription. The state promised to cover these costs for a transition period and seems to have received reassurances from the federal government that Medicare will reimburse these expenses.
• Those with MassHealth do need to pay their co-pay- but it should never be more than $5 (which still can be significant for those with low income, especially if taking more than one prescription drug). The old state law required pharmacies to fill these prescriptions in the absence of a co-pay if the client stated paying the co-pay would pose a financial hardship. Now that Medicare is the first payer, this protection no longer applies.

More details on these issues, along with handouts will be available soon on the department’s website.

-Thanks to Katy Kehoe, Manager, Medicaid Managed Care Plans, Partners Community Benefits, for sharing many e-mails and documents that were basis of this article, will appear on our webpage, and have kept us all informed.

01/2006