What
You Need To Know & Do
| You
Need to Know |
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- If
you are a provider of prescription drugs,
or contract with a provider of prescription
drugs, you will need to make a decision
about participating in one or more of the
Part D Prescription Drug Plans (PDPs). Beginning
January 1, 2006, you will receive
reimbursement only for those Medicare patients
(and particularly those patients covered by
both Medicaid and Medicare, known as “dual
eligibles”) enrolled in PDPs that your organization
has contracts with. The law states that a
PDP must negotiate a contract with any willing
pharmacy that accepts the PDP's standard terms
and conditions. Please study those terms and
conditions and consider the costs and benefits
of becoming a participating pharmacy in one
or more of these PDPs.
- Medicaid
beneficiaries not eligible for Medicare
will continue to receive drug coverage through
the Medicaid program.
- All
Medicare beneficiaries will have
the opportunity to participate in the new
voluntary prescription drug benefit (also
referred to as "Part D").
- About
6 million low-income Medicare beneficiaries
who also are enrolled in Medicaid
(dual eligibles) will be enrolled automatically
into one of the Medicare Part D Prescription
Drug Plans. Beneficiaries who fail to choose
a plan on their own prior to December 31,
2005, will be enrolled in a plan in order
to ensure that they do not lose drug coverage
as they transition from Medicaid to Medicare
for drug coverage. They will have the option
to select a different plan if it better addresses
their needs.
- Limited
income beneficiaries will receive
a prescription drug benefit with low or no
premiums and deductibles and co-payments of
a few dollars per prescription through the
Part D plan. However, as of January 1, 2006,
the Medicaid program will no longer provide
reimbursement for the vast majority of prescription
drugs for dual eligible beneficiaries. The
Centers for Medicare and Medicaid Services
(CMS) is working to ensure the enrollment
process for dual eligible beneficiaries will
be as seamless and efficient as possible.
- PDPs
have already submitted notices of intent
to CMS to become a Medicare Part D PDP; bids
are due to CMS in June. In September, CMS
will announce the list of approved PDPs. Staff
in the CMS Regional Offices are available
to assist you with questions that may arise
as the PDP applicants assemble their networks
of participating providers. CMS
Regional Pharmacist contacts can answer
some of your questions.
- CMS
prescription drug benefit questions &
answers
will help you understand implementation
of Part D benefits. HRSA has received questions
from HRSA grantees and is working with CMS
to develop answers that will be added. Please
use the CMS Web site, contact CMS staff and
attend educational and information sessions
offered by the organizations you typically
work with (e.g., Primary Care Association,
Area Agency on Aging). If you still have questions,
contact your HRSA Project Officer, who can
refer your questions to appropriate HRSA and
CMS staff.
|
| What
You Need to Do |
| |
- Consider
the costs and benefits of becoming
a participating pharmacy in one or more of
the Prescription Drug Plans (PDPs). By law,
a PDP must negotiate a contract with any willing
pharmacy that accepts the PDP's standard terms
and conditions. Study each PDP's terms and
conditions and consider the costs and benefits
of becoming a participating pharmacy in one
or more PDPs.
- Enter
into contracts with PDPs.
Contracting with Safety Net Pharmacy Providers.
- Get
reimbursed. Beginning January 1,
2006, you will receive Medicare
reimbursement only for those Medicare patients
(and particularly those dual eligible patients)
enrolled in PDPs with whom your organization
has contracts.
- Make
your pharmacy known to the PDPs.
CMS is not providing a public list of all
those entities applying to become PDPs. However,
CMS has offered to post on its Web site the
names of pharmacies that are interested in
contracting with PDP applicants so that the
PDPs will know of their interest.
Sign
up to make your contact information available
to Medicare PDPs.
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