- 2010 OPEN ENROLLMENT begins November 15th & ends December 31st for Medicare Prescription Drug and Health Plan Coverage. CMS Encourages Beneficiaries to Review Coverage [more]
- 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 [more]
- CMS reminds Medicare Beneficiaries to review and compare their current drug coverage to make sure it still meets their needs for Plan Year 2009. [more]
- 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, [more]
- 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? Read more details.
- 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.
NEW! How the Coverage Gap ("donut hole") works under Medicare Part D, including costs that do count and costs that don't count toward your true-out-of-pocket costs (TrOOP).
NEW! Online application for financial help with your Medicare Prescription drug plan is available at the Social Security Administration website.
Helping People with Medicare Apply for Extra Help January 2007
Medicare and You , official government handbook (2008)
Kaiser Family Foundation Report compares PDPs for 2007 and 2006 using the CMS landscape file and the CMS Plan Finder website on Medicare.gov.
Important Guide to CMS, SSA and Plan Mailings to Beneficiaries. This CMS chart lists mailings beneficiaires will be receiving and explains what action, if any, they need to take. It includes links to the documents.
Exceptions, Appeals & Grievances
Handling Medicare Drug Plan Complaints (Grievances) updated June 2007/CMS, click here.
CMS site with information and forms covering grievances, coverage determinations, exceptions, appeals, click here.
Examples of Legal Briefs.
To view examples used to win appeals at the IRE and ALJ levels for drugs denied by Part D drugs plans, click here. The briefs have been redacted to protect the confidentiality of the patient and prescribing physician.
If you’ve run into any problems with drug plans (PDPs) failing to follow Part D transition or continuity of care policies, or if you’ve encountered problems with the appeals process, please contact us at PartD@psych.org or 866-882-6227.
Coverage Determinations, Exceptions, & Appeals
For detailed information, click here.
Transition Process Requirements: Part D plans are required to establish an appropriate transition process for enrollees who are transitioning to a Part D plan from other prescription drug coverage.
For patients already stabilized on a drug regimen, Plans are required to provide at least a 30-day transitional supply of non-formulary drugs any time during the first 90 days of beneficiary enrollment. Read more….
Oct 1, 2009: Part D Marketing Activities can begin for the 2010 Part D plans
Oct 15, 2009: CMS Medicare Plan Finder active for 2010
Nov 15 to Dec 31, 2009: Annual Coordinated Election Period for 2010 plan year [Note: next enrollment period is end of 2010 for plan year 2011]
Early Dec: CMS recommended date to avoid problems/delays in 2010 Part D coverage
Jan 1, 2010: Effective date of coverage. If switching plans, date old plan will be discontinued automatically.
Jan 1 to Mar 31, 2010: Special Enrollment Period. This SEP allows MA-PD enrollees to enroll in a PDP and is limited to 1 enrollment.
Jan 1 to Dec 31, 2010: Persons turning 65 can enroll in a 2010 Medicare Part D Plan. Medicaid recipients can enroll or change their enrollment in a 2010 Medicare Part D Plan.
For information from CMS on Pharmaceutical Assistance Programs, click here.
Providers
NEW NUMBER: APA Part D Helpline
800-343-4671 or PartD@psych.org
Consumers
NMHA Mental Health Resource Center
800-969-6642
