About The Benefit

Links to Reference Materials

CMS - Medicare - Official Web Site

Part D in 2009

Part D Plan Enrollment Data

Costs

• Late Enrollment Penalty Premiums - About Them
• Late Enrollment Penalty Premium Decisions - Appealing Them
• Part D Plan Premium Withholding By Social Security
• Reimbursement for Premiums and Co-pays Paid Out-of-Pocket (CMS, June 2007)
• Understanding True Out-of-Pocket Payments, or TrOOP (CMS, December 2007)
• Creditable Coverage and the Late Enrollment Penalty Premium

Coverage

• All Drugs in Certain Categories
• Getting Prescriptions Filled - Best Available Evidence Rule
• Niacin
• Transition Policies
• Vaccine Coverage (CMS, June 2007)

Formulary

• Changes During the Year
• CMS Guidance for 2007
• Exceptions and Appeals

Legal Authorities

• Medicare Modernization Act
• Part D Manual - Rules
  • Chapter 2 - Marketing
  • Chapter 3 - Eligibility and Enrollment
  • Chapter 4 - Creditable Coverage and Late Enrollment Penalty
  • Chapter 5 - Benefits (Types of Plans) and Beneficiary Protections
  • Chapter 6 - Formulary Rules
  • Chapter 7 - Quality Improvement and Medication Therapy
  • Chapter 9 - Fraud Waste and Abuse
  • Chapter 14 - Coordination of Benefits
  • Chapter 18 - Enrollee Appeals and Grievances
• Part D Regulations (42 C.F.R. Section 423)

Part D Template Materials from CMS

• ANOCs and EOCs - 2008
• Updated Model EOB - July 2008
• At the Pharmacy - 2008
• Model Formulary Disclosures

Problems and Solutions at the Pharmacy

• 4-Step Point-of-Sale Enrollment (CMS, January 2007)
• Health Care Professionals' Part D Fact Sheet
• Pharmacists Part D Reference Guide
• Pharmacy-to-Doctor Fax Form
• Point-of-Sale Enrollment (CMS, December 2007)
• Using a New Part D Plan at the Pharmacy (CMS, December 2007)