Part D Appeals rules simplified: Effective March 13, 2009, after notifying the patient, a physician may ask a Part D drug plan for reconsideration of a drug coverage denial without a completed “appointment of representative” (AOR) form from the patient prior to contacting the plan. Previously, physicians could request initial determinations and expedited appeals from plans, but could not proceed further in the appeals process. The new rule from CMS is expected to expedite the appeals process.
Alert! 1/12/09 CMS suspends enrollment and marketing for WellPoint Prescription Drug Plan and MedicareAdvantage contracts
CMS reminds Medicare Beneficiaries to review and compare their current drug coverage to make sure it still meets their needs for Plan Year 2009.
Online search: 2009 Medicare prescription drug plan and health plan information is now online through the Medicare Prescription Drug Plan Finder at www.medicare.gov. You can compare plans and search plan formularies.
Download publication: Choosing a Medicare Plan: Important information from Medicare & You 2009 (CMS publication): Each Medicare drug plan is different. When you choose a Medicare drug plan for the first time, or switch to a different Medicare drug plan,
Low-Income Subsidy Beneficiaries: important dates & mailings Read more details.
Switches at the Pharmacy Counter—Therapeutic Substitution Required therapeutic substitution poses serious risks to the health and safety of patients and interferes with appropriate medication decisions Read more details.
2008 Quality and Performance Ratings for 15 Part D Prescription Drug Plans.This is a sampling of national and regional plans. There are two types of Medicare plans that provide prescription drug coverage: Medicare PDPs (Prescription Drug Plans) and Medical Health Plans. The MA-PDs offer both health care and prescription drugs while the PDPs offer only prescription drug coverage. To compare other PDPs or MA-PD plans in a particular state (or county) use the Plan Finder tool on www.medicare.gov. Read more details.
Need to be paid back for Medicare drug plan copayment and/or premium amounts?
Overview of Medicare Drug Coverage Under Medicare Part A, Part B and Part D Read more details.
Alert: Victims of Marketing Fraud can Disenroll from MA Plans. Individuals who think their enrollment in a Medicare Advantage (MA) plan was based on misleading or incorrect information provided by the Plan’s employees, agents or brokers should call 1-800-MEDICARE. Customer service representatives at 1-800-MEDICARE and CMS regional office (RO) caseworkers will evaluate beneficiaries’ requests to disenroll and reenroll in a different plan during the Special Enrollment Period.
Important Clarifications on Prior Authorization and Utilization Management Requirements: CMS requires all Part D plans to inform patients and their physicians of “specific prior authorization criteria and other utilization management requirements.