Refills of Part D Medications for residents in a declared Public Health Emergency Area

CMS expects Part D sponsors to guarantee immediate refills of Part D medications to any beneficiary located in an “emergency area,” defined as the area in which the President has declared a major disaster or the Secretary of the Department of Health and Human Services (DHHS) has declared a public health emergency.

For those enrollees residing in the emergency area, CMS would expect all “refill too soon” edits to be removed for the period of the emergency declaration. Additionally, because the following conditions might exist during an emergency: a limited number of operational pharmacies, limitations on transportation and travel, and the disruption of U.S. mail – CMS expects sponsors should always allow an affected enrollee to obtain the maximum extended day supply, if requested and available at the time of refill.

Part D sponsors should remove refill too soon edits for those enrollees whose primary residence is located in the geographic area identified in the declarations, regardless of the location at which they are attempting to obtain a refill. At the end of the emergency declaration, as specified in the aforementioned Web sites, Part D sponsors should re-implement their edits, and all plans should continue to work closely with enrollees who are displaced or otherwise impacted by the disaster.

To effectuate these policies, CMS expects sponsors to continuously monitor the Federal Emergency Management Agency (FEMA) Website (http://www.fema.gov/news/disasters.fema) for issuance of Presidential major disaster declarations and the DHHS Website.

This news update was originally published on June 18, 2008.