Mental Health Part D News Alert

December 15, 2005

CMS released the Plan Finder tool in October to assist people with Medicare with reviewing their prescription drug plan options.  We have tested the tool and wanted to let you know that CMS is aware of several functional problems and continues to refine the site.  However, the site can be used to gather basic information. 

Here are some updates on the Plan and Formulary Finder to date:

Are the Plan Finder and Formulary Finder fully functional?
According to CMS, yes, and all information is accurate to what was provided to them by the plans. However, it is important to note that not all of the drug plans have submitted all of the information that was requested of them by CMS.  On November 7, detailed pricing data was added to the site, allowing users to compare drug costs and calculate total costs for the individual based on their medications. On November 14, the online enrollment center and a Spanish-language version of the Plan Finder tool were added to the site.  There are still some issues: slow site, links not functioning, but generally it’s working.  Some tips/new features:

• The online enrollment tool can assist in enrolling individuals in all plans except the 54 that chose not to participate in that option (waiting for clarification from CMS). Users can access the online enrollment form by clicking on an Enroll in a Plan button in five locations:
• On the Plan Finder homepage
• After searching the Plan Finder, each Plan detail page has a link to enroll
• On the Personalized search page
• On the detailed cost comparison page
• On the Medicare.gov personal plan finder page (for general Medicare plans)
• When doing a search based on medications, the tool will identify plans which cover the search medications and the user can click on the medication to get further detail about whether prior authorization, step therapy or quantity limits apply, and what copayment tier the medication is in if the drug plan has made this information available. An ** in that box indicates a non-formulary medication.
• Since late November, CMS says that duals have been able to enter their personal information and can automatically compare the plan to which they’ve been autoenrolled to other plan options in their region.
• When conducting a personalized search for an individual, CMS admitted that dual eligibles are not differentiated from individuals eligible for the Extra Help, so the default information on copayments will show $2-5, rather than the $1-3 that will be applicable to most full benefit duals.
• The Plan Finder/Formulary Finder tool will only identify network pharmacies within a 50 mile radius of the individual. In rural states, this may (and is) limiting the choice of plans in some cases.
• When entering medications to conduct a personalized search, users are not able to enter the same medication in two different dosages (e.g., if an individual is on the same medication but different dosages in the morning and evening – and thus two separate prescriptions). CMS is aware and I await a response on how to get around that…
• Some plans are offering no copays – principally for generic medications only.

 

Below are the basic things you need to know about the Plan Finder tool:

The plan finder can be found at http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/Questions.asp Individuals can conduct a personalized search by entering their Medicare insurance information and zip code.  They will need their Medicare claim number found on their Medicare insurance card, a list of their medications, and the doses of the medications.  Individuals can also conduct a general search but cannot search for multiple medications with this tool (see formulary finder, below).  This involves multiple screens and requires the individual to go to the individual plan formularies to verify information on prior authorization requirements and co-payment tiers.

The formulary finder allows individuals to search available plans by the list of medications the individual is currently using.  The direct link to the formulary finder is: http://plancompare.medicare.gov/formularyfinder/selectstate.asp  The user may list multiple medications and may view the results according to the exact dosages they take or based on the most common dose as covered by the formulary.  The formulary finder gives the user a list of plans, which cover all or some of the medications in the person’s list.  The tool also identifies whether those medications have co-payment tiers; and whether the medications require prior authorization or step therapy.  Individuals will have to access the specific formulary of a specific plan to get details for the co-payment amounts and prior authorization requirements either by calling the plan or using the plan finder tool above.

To quickly find a list of plans offered in your state/region, use the following link: http://www.medicare.gov/MPDPF/Public/Include/DataSection/Results/ListPlanByState.asp?dest=Nav|Home|State|ListPlanByState#TabTop.  This chart contains information about contacting the plan by phone as well as general information about premiums and deductibles.

We will continue to update the site as refinements to the Plan Finder tool are made.