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Early 2010 Part D Help Guide

General Ways You Can Help Your Clients:

• Receipt of 2010 Plan Membership Card: Make sure your clients have received a new membership card or letter confirming enrollment into their 2010 Part D plan.  Both of these documents contain the data (called 4RX) needed by pharmacies to submit claims and fill prescriptions. Any clients who do not have their 2010 ID card or letter confirming enrollment, such as those who enrolled during the last few days of December 2009, should be in touch with their 2010 Part D plan ASAP to make sure their coverage is up to date so they can fill their prescriptions!
  
  
• Confirmation of Enrollment: If your clients have a www.MyMedicare.gov account they can confirm their Part D plan enrollment for 2010. The Medicare Plan Finder personalized search and 1-800-MEDICARE also have 2010 enrollment information.  Pharmacists have access to this information through an enhanced E-1 query.
  
  
• Counseling Re-assigned Clients: Your re-assigned clients may seek your assistance to research the cost, coverage and convenience of the plan to which they were re-assigned. You can counsel them about the comparative pros and cons of accepting the re-assignment versus selecting a plan for which they might have to pay a portion of the premium out-of-pocket but may have access to a more generous formulary. Either way, these clients will still pay only the applicable LIS copayments when they fill their prescriptions. You can also remind these clients that people with LIS/Extra Help may switch plans as frequently as monthly, although frequent switching is usually not a recommended tactic.

Helping When Your Clients Are At the Pharmacy

• Bring Proof of the 2010 Plan: Emphasize to your clients the importance of bringing their 2010 membership card or enrollment confirmation with them to the pharmacy when they refill their prescriptions, especially the first time they use their Part D plan in 2010.  This will make it easier for the pharmacy if the claims system doesn’t return an E-1 query with accurate enrollment or LIS/Extra Help status.
  
  
• Transition Fills: Have information ready for your clients and community pharmacies about transition fills. Remember plans are required to fill ongoing prescriptions the first time a new member goes to the pharmacy, even when the drugs aren't on the formulary, or are limited by utilization management requirements, then send an explanatory letter within 3 days of the fill. View the transition requirements provisions in Chapter 6 of the Medicare Prescription Drug Manual.
  
  The pharmacy will also get a message through its electronic claims submission and can also give people a "heads-up" about the temporary nature of a Part D transition fill. Your clients should use the transition period to work with their treating physician to decide whether it’s ok to switch to a drug the plan covers with no limitations on access, or to request a formulary exception.
  
  
• Best Available Evidence: Tell your Extra Help clients how they can show the pharmacy proof of their Extra Help status so they can get their prescriptions by paying the Extra Help co-payments even if the E-1 query does not confirm that they have Extra Help. We discuss Best Available Evidence in the Library under Extra Help.
  
  
• Point-of-Sale Enrollment: If the pharmacy cannot identify the plan of an Extra Help beneficiary, be prepared to assist your clients and their pharmacies with information about the Point-of-Sale enrollment solution. The new Limited Income NET program (LiNET), run by Humana, will handle point-of-sale enrollment starting in 2010. Learn more about LINet on My Medicare Community. Or check out the LINet Web site.
  
  
• Extra Help Grace Period: For your clients who were unredeemed, ask their plan if it adopted the three-month grace period during which the plan forebears on collecting premiums and cost sharing.  Assess whether these clients should apply for Extra Help, or can re-gain Medicaid status through an income spend-down or Medicare Savings Program eligibility.

Medicare Advantage Open Enrollment Period (MA OEP):

Between January 1 and March 31, 2010, all of your clients who have Medicare Parts A and B can switch among Medicare Advantage plans if they are enrolled in one as of January 1, 2010. They also can disenroll from Medicare Advantage to Original Medicare, or can join a Medicare Advantage plan if they are in Original Medicare as of January 1, 2010.

Remember that they cannot use this Medicare Advantage enrollment period to add or drop Part D. Find out what changes can your clients make during the Ma OEP.

Remember that anyone using the MA OEP to go to Original Medicare should be screened for Medicare Savings Program eligibility, or should be assisted to explore Medicare Supplemental Insurance coverage (Medigap).

Ideas to Consider for Longer-Term Solutions:

• Extra Help Special Enrollment Period: Your Extra Help clients may switch plans as frequently as monthly.  Such frequent switches are generally not advisable; but if they are dissatisfied with their plan, changing to another one may be a strategy your clients would want to consider.
  
  
• Exceptions and Appeals: You can work with your clients and their physicians to request formulary exceptions to cover drugs the doctor believes your clients should continue to take even if they were removed from the formulary for 2010, were tiered up and are too expensive, or are newly subject to utilization management requirements such as prior approval, step therapy, or quantity limits. 

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