Medicare Drug Coverage:
Partnering with Providers

Background Information

FAQ

Training Materials

Conference Calls

Background Information

HAP Resources

• Helpful Information to Share with Pharmacists Serving Medicare Beneficiaries This tool provides a one-stop resource for helping pharmacists to identify the common reasons that prescription claims for Medicare beneficiaries are being denied by Part D plans. The guide also offers step-by-step solutions for each issue.
• Pharma-Gram A brief "takeaway" for beneficiaries to pick up at the pharmacy counter if they are having trouble getting their prescriptions filled. Provides specific action steps.
• Quick Guide to Exceptions for Consumers This handout may be used in the pharmacy to educate consumers about what they can do if their drugs are not covered by their Part D plans. It also provides a brief overview of the steps to request a formulary exception and, if necessary, file an appeal.
• Partnership Opportunities- Because pharmacists and doctors are playing such a large and important role in helping Medicare beneficiaries access their drugs through Part D plans, HAP has compiled the contact information in each state for the following organizations:  
  • State Boards of Pharmacy
  • State Medical Boards
  • State Pharmacy Associations
• Summary of the CMS Long-Term Care Guidance An explanation of the CMS guidelines for Part D Plans with respect to beneficiaries in long-term care facilities. 
• Enrollment Reconciliation Process 

CMS Resources

• Physician Fact Sheet
• Handling Medicare Part D Prescription Drug Plan Complaints
• Part D Reference Document for Pharmacists
• Part D Exception and Prior Authorization Form. This standard form can be used by physicians to request a formulary exception or other coverage determination for the majority of prescription drugs from any Part D plan.
• Request for Prescription Information or Change Form.  This general fax form has been approved for use by CMS. It was developed by the Center for Medicare Advocacy, along with The Alzheimer's Association, American Medical Association, American Pharmacists Association, Medical Group Management Association, National Community Pharmacists Association and the National Council on the Aging as a form for pharmacists to fax to physicians when there are issues with their Medicare patients' prescriptions.

CMS Updates

• Partnering with Providers Updates 

FAQ

• Common Questions: Medicare Drug Coverage and Long-Term Care Residents? FAQ regarding Medicare Part D and its implications for residents in long-term care facilities.

Training Materials

Conference Calls

January 17, 2007: At the Pharmacy Counter- Helping Beneficiaries Get Their Prescriptions

June 21, 2006: Talking to Part D Plans: A HIPAA Privacy Refresher

January 18, 2006: First Aid Kit for Part D