Archive
I. Conference Call Information (March 15, 2006)
II. In the News
McClellan Testifies on Part D Implementation
CMS Warns of “$299 Ring” Phone Scam
Federal Court Restores Neurontin Coverage for Pain in Florida Medicaid
Federal Private Insurance Bill Moves to Senate Mark-up
III. Helpful Information
New Study Examines States' Plans for Filling Medicare Part D Gaps
Tip Sheet on Using Part D Coverage Before the Card Arrives
CMS Touts Significant Savings through Medicare Drug Coverage
Revised Caregiver Guide Now Available
New Fact Sheet for Physicians on Part D Resources
IV. HAP Resources
Medicare Part D FAQs
New HAP Web Address for SHIP Questions
Materials on Adolescent Health and Medicaid
V. Other Resources
New York Attorney General Establishes Drug Pricing Website
I. Conference Call Information
The next Medicare Network Conference Call, “Beyond the Theory of Exceptions and Appeals,” will be held next Wednesday, March 15, at 3:00 p.m. EST. We will discuss strategies to assist beneficiaries with understanding the transition period, and to inform providers about the importance of applying for exceptions during the transition. For more information or to make suggestions for this Conference Call, please contact Kelly at kbrantley@healthassistancepartnership.org or (202) 737-6340.
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II. In the News
McClellan Testifies on Part D Implementation
On March 1, The Centers for Medicare and Medicaid Services (CMS) Administrator, Dr. Mark McClellan, gave testimony before the House Energy & Commerce Subcommittee on Health hearing on Medicare Part D, and implementation of the new prescription drug benefit. Dr. McClellan reported on enrollment numbers, outreach and education initiatives, and steps being taken to resolve implementation issues, particularly for dually eligible beneficiaries. For more details, see Dr. McClellan's written testimony.
CMS Warns of “$299 Ring” Phone Scam
On Tuesday, March 7, CMS’s Office of Public Affairs issued a warning to beneficiaries to be on the look-out for phone calls from bogus Medicare drug plan representatives who ask for money and checking account information to enroll in a plan. Typically, the callers ask beneficiaries to pay a sum of $299. Legitimate prescription drug plans cannot ask for personal information over the telephone. Medicare has received reports of this fraud from Indiana, Michigan, Pennsylvania, Massachusetts, New Jersey and Georgia.
Federal Court Restores Neurontin Coverage for Pain in Florida Medicaid
The National Health Law Program announced last week that a federal district judge in Miami issued a summary judgment and permanent injunction allowing Medicaid patients in Florida to use the drug Neurontin and its generic equivalent to manage nerve pain and mood disorders. Jane Perkins of the National Health Law Program wrote, “Although Neurontin has been approved by the U.S. Food & Drug Administration (FDA) as an anti-seizure medication, it is also listed in Congressionally-approved drug compendia as a medication for pain-related and other conditions. In 2004, the State of Florida issued a formal policy denying Medicaid reimbursement for Neurontin for any use not approved by the FDA and for which there was not a double-blind placebo controlled study confirming its effectiveness. This meant that almost all ‘off label’ uses of the drug were denied. Counsel for the Edmonds class argued to Judge Klein that the Medicaid Act specifically requires states to reimburse drugs for their "medically accepted indications" referenced in Congressionally-recognized drug Compendia. See 42 USC 1396r-8(d), 1396r-8(k)(6)?. The court agreed with the beneficiaries that the State's restrictive criteria were contrary to Medicaid law.”
Federal Private Insurance Bill Moves to Senate Mark-up
The Senate Health, Education, Labor, and Pensions committee on Wednesday began its mark-up of Senate Bill 1955, the Health Insurance Marketplace Modernization Act. The mark-up will continue next Wednesday, March 15. While its stated purpose is to “expand health care access and reduce costs through the creation of small business health plans and through modernization of the health care insurance marketplace,” it would also profoundly alter the regulation of health plans by states in two ways.
First, all insurers offering coverage in the group or individual markets (not just insurers of small businesses) would be allowed to provide a “Benefits Choice” for both group and individual plans. They could offer coverage in any of these markets that do not meet state mandates, as long as they also offer at least one policy that includes the benefits of one of the five most populous states’ employee coverage plans. Secondly, after a transition period, fully-insured group plans for small business would follow 1993 National Association of Insurance Commissioner (NAIC) rating rules rather than state rules. Thus, the federal law would preempt state laws that establish community rating or other rate bands. Several national groups, including several disease societies, the National Conference of Insurance Legislators, unions, and consumer organizations such as Families USA, are very concerned about the potential loss of state benefit and rate protections.
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III. Helpful Information
New Study Examines States' Plans for Filling Medicare Part D Gaps
The Muskie School of Public Service at the University of Southern Maine has released a report analyzing the results of a survey conducted in Nov. 2005 of selected state Medicaid and SPAP agencies about their plans to wrap around the Medicare Part D benefit beyond the initial emergency transition period. Among the key findings are that most states are not filling the Medicare Part D gaps for dual-eligibles, with the exception of coverage for Part D excluded drugs. A few states such as New York, New Jersey, Maine, Nevada and Missouri, reportedly intend to fill the other Part D gaps for their very low-income beneficiaries. For the complete findings, please see the full report.
HAP also has a chart of stop-gap measures that states and municipalities have taken on behalf of their dually-eligible and low-income populations.
CMS Postings
Tip Sheet on Using Part D Coverage Before the Card Arrives
CMS has distributed a new tip sheet, Using Medicare Prescription Drug Coverage Before Receiving a Drug Plan Membership Card, to describe suitable documentation for beneficiaries to present at a pharmacy in absence of their plan membership cards. Acceptable temporary substitutes include letters from the enrollee's plan, or a Medicare card and a copy of a current Medicaid award letter for dually eligible beneficiaries.
CMS Touts Significant Savings through Medicare Drug Coverage
CMS’s Office of External Affairs recently released a fact sheet outlining how Medicare drug coverage provides significant price discounts and savings. CMS asserts that prescription drug plan enrollees are saving significant amounts of money on their drugs compared to what they would have paid without Part D coverage. Some factors which may help save money include enrolling in lowest-cost plans, switching to generic medications, and using the mail-order option. CMS also claims that beneficiaries can get discounts on drugs largely because of competition and negotiated prices among the plans. For more information, see the full report and analysis. CMS also made available a chart featuring illustrative profiles of beneficiaries, from selected locales, who have common chronic conditions. These spreadsheets show the money that has been saved through Part D prescription drug coverage.
Revised Caregiver Guide Now Available
CMS recently released a revised version of Medicare Basics: a Guide for Families & Friends of People with Medicare. Geared towards caregivers, this resource highlights important information needed to make Medicare-related health care decisions.
New Fact Sheet for Physicians on Part D Resources
This new piece outlines relevant information for physicians regarding Part D transition policy, and exceptions and appeals processes. The fact sheet contains information about covered and non-covered drugs, resources specific to physicians, a glossary of commonly used Medicare-related terms, and a description of the physician's role in coverage determinations, exceptions and appeals processes.
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III. HAP Resources
Medicare Part D FAQs
HAP is posting today a new Medicare Part D Frequently Asked Questions(FAQs) page. The answers are in response to questions posed from diverse sources, including SHIPs and their aging network partners, as well as from a variety of forums including HAP trainings, HAP and CMS conference calls, and calls hosted by other organizations. HAP will update the questions twice a month.
If you have a question that you would like to ask HAP or need further clarification about an answer posted on our FAQ page, please e-mail it to shiphelp@healthassistancepartnership.org (see next item).
New HAP Web Address for SHIP Questions
Because we are all extremely busy with Medicare Part D, HAP has created a new email address specifically to respond to SHIP questions and needs in the most efficient manner. We encourage SHIPs and their partners to send all inquiries and requests for technical assistance to shiphelp@healthassistancepartnership.org. A HAP staff member will respond to your inquiry within 2 business days. You are, of course, more than welcome to contact the staff person who responds to your request by phone or email. We look forward to continue receiving many wonderful and challenging questions from all of you!
Materials on Adolescent Health and Medicaid
Last month, we had planned a conference call on adolescent health and Medicaid. We changed the call’s topic to talk instead about federal changes to Medicaid. We did, however, prepare materials about adolescents’ rights to health screening and treatment, confidential services, and ways that teens can qualify for Medicaid. Please contact Cheryl Fish-Parcham, cparcham@healthassistancepartnership.org, if you have questions or comments.
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V. Other Resources
New York Attorney General Establishes Drug Pricing Website
The New York Attorney General, with the help of AARP volunteers, established a website, that compares the prices of 150 commonly prescribed medications in various pharmacies in the state of New York. According to the companion report, savings of up to $85 per prescription are possible by comparison shopping. Consumers can save an average of $17.36 per prescription by buying their medications at the lowest prices reported on the website.
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