Archive
I. Conference Call Information
Next Medicare Conference Call
II. In the News
More than 600,000 Enroll in Part D Plans as Initial Enrollment Period and Medicare Drug Discount Card Program Conclude
CMS Seeks Comments on Notices for Extra Help Recipients
III. Helpful Information
KFF Issue Brief Compares PDP and MA-PD Cost-Sharing
CMS Q&A on Formulary Change Notices and State Marketing Law Preemption
IV. HAP Resources
New COBRA and Creditable Coverage Fact Sheet
“Shiphelp” Success Story
HAP’s FAQ Resource Center
“HAPpy” Hour at the Annual SHIP Director’s Conference
HAP is Hiring!
I. Conference Call Information
Next Medicare Conference Call
HAP’s next Medicare Network Conference Call is scheduled for Wednesday, June 21, at 3:00 p.m. EDT. Look for details in a future edition of the Weekly Email.
II. In the News
More than 600,000 Enroll in Part D Plans as Initial Enrollment Period and Medicare Drug Discount Card Program Conclude
In an email on Monday, May 15th to subscribers to the MMA Pharmacy Listserv, S. Lawrence Kocot, Senior Advisor to CMS Administrator Mark McClellan, wrote that nearly 600,000 additional Medicare beneficiaries signed up for Part D plans in the days leading up to the enrollment deadline. Mr. Kocot also reminded pharmacists that Monday marked the end of the Medicare Approved Drug Discount Card program. In a “Pharmacy Advisement” attached to the Kocot email, the Centers for Medicare & Medicaid Services (CMS) stated that “all Medicare Prescription Drug Discount Card benefits (both discounts and transitional assistance) must be discontinued and discount cards deactivated” after 1:59 p.m. local time on May 15. The pharmacy advisement also noted that on May 1 the agency encouraged, but did not require, drug card sponsors to consider sending a letter to drug card members advising them of the program’s end and encouraging them to enroll in a Part D plan by May 15.
Later in the week, CMS issued an updated fact sheet on enrollment activity in which the agency reported that Part D plans have already processed 872,000 new applications since May 7, not including those from the “last-minute enrollment surge,” and that 90 percent of Medicare beneficiaries have some kind of prescription drug coverage.
CMS Seeks Comments on Notices for Extra Help Recipients
CMS’s Division of Partnership Development announced on May 16 that it is seeking comments on two draft prescription drug notices that the agency would send to beneficiaries who lose their deemed eligibility for the Extra Help subsidies (following a re-deeming review in August), or whose Extra Help co-payment levels will change in 2007. Comments are due by close of business on Monday, May 22. You can email comments to Erin Gordon at Erin.Gordon@cms.hhs.gov.
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III. Helpful Information
KFF Issue Brief Compares PDP and MA-PD Cost-Sharing
The Kaiser Family Foundation (KFF) on May 16 released a new issue brief that looks at the premiums, deductibles and other cost-sharing features in Part D prescription drug plans, including the differences between Medicare HMOs, PPOS, Private-Fee-for-Service plans, and the stand-alone prescription drug plans (PDP). KFF found that the average premium for Medicare Advantage plans with drug coverage (MA-PD) is about half that for stand-alone PDPs. MA-PDs, on average, charge $18 per month for their Part D drug coverage, while PDPs charge an average of $37 per month. In addition, KFF found that 49 percent of the local Medicare HMOs nationwide offer Part D drug coverage with no monthly premium, a result of a recent federal policy choice that requires Medicare to pay more for beneficiaries who enroll in private plans than it does for those who enroll in traditional, government-run, Medicare. These payment incentives, in large part, spurred the creation of many of the 1,314 MA-PDs that exist nationwide.
CMS Postings
CMS Q&A on Formulary Change Notices and State Marketing Law Preemption
CMS issued a series of Part D Question & Answer documents during the past week. We report on two of them. One Q&A addresses the agency’s requirements for Part D plans to notify enrollees of formulary changes for an upcoming contract year. CMS’s explains that plans must provide enrollees with an “annual notice of change,” or ANOC, by October 31st prior to the start of the new contract year. CMS, however, does not require the Part D plans to use the ANOC to inform enrollees of specific formulary changes that could affect them directly, nor does it require the plans to provide a separate 60-day notice of upcoming changes. The reason for this, CMS explains, is that the agency views the upcoming year’s formulary as a new formulary. The Q&A also describes exceptions and transition procedures related to these formulary changes.
CMS’s second Q&A deals with questions about federal preemption of state consumer protection laws as to Part D plan marketing practices and registration laws for telemarketers. CMS clarifies that federal Medicare law and regulations generally preempt state law (except for licensure and solvency requirements) as to Part D plan marketing violations. The agency asserts that “states may not take enforcement action against a Part D plan sponsor or Medicare Advantage Organization for an alleged violation of any such state marketing law,” because Congress intended for CMS to regulate these contractors’ marketing materials.
For more information on Part D marketing guidelines and program integrity, also see HAP’s Medicare Part D Marketing Guidelines Fact Sheet.
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IV. HAP Resources
New COBRA and Creditable Coverage Fact Sheet
HAP has created a new fact sheet to address whether COBRA coverage is creditable. In recent weeks HAP has received many requests for technical assistance on the issue of COBRA coverage. This tool outlines the sections of statutes and CMS guidance statements which address the definitions of creditable coverage, group health plans, and COBRA. If you have any additional questions about COBRA or creditable coverage not addressed by this fact sheet, please send them to shiphelp@healthassistancepartnership.org.
Shiphelp” Success Story
The following story illustrates how HAP’s “Shiphelp” resource can assist you in resolving problems and answering questions. HAP can help you find remedies for beneficiary problems. When you need support to find resolutions for the beneficiaries you are helping, send an email to Shiphelp@healthassistancepartnership.org. HAP staff responds to Shiphelp inquiries within two work days.
Recently a SHIP partner organization contacted HAP through Shiphelp about an MA-PD enrollee who had difficulty filling his prescription. The pharmacist told him he'd have to pay $2,200 each month for a medication that stabilized his very serious medical condition. A counselor asked the plan for an explanation and a coverage determination. The plan stated in response that in compliance with formulary rules it had submitted to CMS, it would pay a maximum of $500 per prescription fill on this Tier III drug, and the beneficiary would have to pay the balance out-of-pocket each month. The counselor did not understand this; it was inconsistent with the information posted in the plan’s online formulary and within the CMS Plan Finder. She contacted the plan and the CMS Regional Office (RO) for clarification, but received no responses. Upon consultation with HAP, the counselor requested a redetermination, while HAP contacted the CMS Central Office. Within two hours, the plan retracted its position and informed the counselor that the beneficiary could fill the prescription with monthly $20 copays. HAP has requested clarification as to how CMS will assure that any other enrollees who were affected by this plan's erroneous understanding of cost sharing for Tier III drugs will be notified of the mistake.
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HAP’s FAQ Resource Center
We want to draw your attention to the growing list of entries on HAP’s Frequently Asked Questions (FAQ) Resource Center. The FAQ Resource Center is a central location for many of the questions that come to HAP from SHIPs and other advocates across the country. Many of the answers also contain reference information for those interested in a more complete answer. For more information on our FAQ resource, please contact Kelly Brantley at kbrantley@healthassistancepartnership.org. Here’s a sample from the Resource Center’s “Exceptions & Appeals” category:
Q. How can a SHIP help a Part D plan enrollee who has not received a response to her request for an “exception” to the plan’s formulary within the required 72 hour time frame?
A. CMS has asked plans that do not issue a decision to enrollees within the 72-hour timeframe to provide enrollees with a transition fill, thereby allowing enrollees to receive their medications until the plan issues a favorable decision or forwards the exception to the second level of the appeal process. (The second level of the appeals process, known as "Reconsideration," is conducted by an Independent Review Entity or IRE). CMS has stated that SHIPs should contact the CMS Regional Offices if plans are not in compliance. Additionally, HAP is willing to assist SHIPs in these efforts to assure that Medicare beneficiaries have appropriate access to medications through their Part D plans.
“HAPpy” Hour at the Annual SHIP Director’s Conference
HAP is hosting a reception at the Annual SHIP Director’s Conference on Monday, June 26, 2006 from 5:30 to 7:30 pm in the Windows Room. We invite you to stop by to chat with HAP staff and other SHIP personnel from around the country. Light appetizers will be provided and a cash bar will be available. If you have any questions, please contact us at infohap@healthassistancepartnership.org
HAP is Hiring!
HAP is currently seeking to hire a Senior Education and Counseling Associate and a Web Tools Project Manager to work in its DC office. Please see the job announcements on our new “Employment Opportunities” page for more information about these positions.
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