Letter from HRSA Adminstrator Elizabeth M. Duke to HRSA
Grantees
Regarding Implementation of the Medicare Prescription Drug Benefit
Department of Health and Human Services
Health Resources and Services Administration
Rockville, MD 20857
June 14, 2005
Dear HRSA Grantee:
Changes in the Medicare program will soon take place that will have a
great impact on you and the many clients you serve. The Centers for Medicare
and Medicaid Services (CMS) has the lead on the implementation of the
Medicare Prescription Drug, Improvement and Modernization Act of 2003
(MMA), and we at HRSA are partnering with CMS to provide relevant information
to HRSA grantees, safety-net providers and their clients.
Beginning in 2006, the MMA makes prescription drug coverage available
to all 43 million Medicare beneficiaries. This important new benefit will
help beneficiaries in paying for their prescription drugs. The law also
lets Medicare -- for the first time in the program's 40-year history --
provide additional help to those in greatest need, especially beneficiaries
with very high prescription drug costs and people with low incomes.
The law also creates new Prescription Drug Plans which may have a significant
impact on the reimbursements you receive for Medicare clients. Some details
about this are included in a separate attachment.
Our primary concern for the Medicare beneficiaries you serve is that
they continue receiving the medications they need to stay healthy. We
also want to help CMS implement this new prescription drug option as smoothly
as possible. In the coming months, HRSA, along with other Federal agencies,
will take part in a massive education outreach effort. We will work with
CMS to ensure you have the most current information so that you can assist
your Medicare patients in making the best choices in meeting their prescription
drug needs.
Sincerely,
Elizabeth M. Duke
Administrator
WHAT YOU NEED TO KNOW NOW…
- 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) operating
in your State. Beginning January 1, 2006, you will be able to 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"). For the some six-million low-income beneficiaries
who also are enrolled in Medicaid, CMS plans to automatically enroll
them into one of the Part D 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 these beneficiaries do not lose drug
coverage as they transition from Medicaid to Medicare for drug coverage.
Beneficiaries, however, will have the option to select a different plan
if it better addresses their needs.
- Through the Part D plan, 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. 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.
CMS is working to ensure the enrollment process for dual eligible beneficiaries
will be as seamless and efficient as possible.
- We know that PDPs have already submitted their notice of intent to
CMS to become a PDP, and 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.
A list of CMS Pharmacist contacts, who can answer some of your questions,
is provided at the bottom of this message.
- To help you understand implementation of Part D benefits, CMS has
posted Qs&As on their Web site. The CMS Qs&As can be found at
http://questions.cms.hhs.gov/.
We already have received questions from HRSA grantees and are working
with CMS to develop answers for those questions so they can be posted.
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 remaining questions, please contact your HRSA Project
Officer so they 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).
- Enter into contracts with PDPs.
- Get reimbursed. Beginning January 1, 2006, you will be able to 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.
If your organization would like its contact information shared with
PDPs via the CMS Web site, please visit http://www.cms.hhs.gov/pdps/
and click on “Interested Third Party Information.” Instructions
are provided for completing the form, “Parties interested in contracting
with Part D applicants.” Once you send in this form, your organization’s
name will appear on CMS’ list indicating to PDPs that you are interested
in contracting with them.
WANT MORE INFORMATION?
For more detailed information about MMA and the upcoming changes that
will affect you, please visit http://www.cms.hhs.gov/providers/.
To obtain information on educational materials CMS is making available
to share with beneficiaries, please visit http://www.cms.hhs.gov/partnerships/.
Updated information tailored for safety-net providers can be found on
HRSA's Office of Pharmacy Affairs Web site at http://www.hrsa.gov/medicare/.
Medicare Modernization Act
Pharmacy MMA Information
Contact CMS
Contact a CMS Pharmacist
CMS Pharmacists are available to answer your questions about Medicare
Prescription Drug Coverage. Our Pharmacists are located in each of our
ten regional offices; scroll down to find the regional office that serves
your area.
Beneficiaries may call 1-800-Medicare (1-800-633-4227) or visit Medicare.gov
for more information about Medicare programs.
Region I (Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island, and Vermont)
Adele Pietrantoni
adele.pietrantoni@cms.hhs.gov
(617) 565-3312
Region II (New Jersey, New York, U.S. Virgin Islands, and Puerto
Rico)
John Cocchiara
john.cocchiara@cms.hhs.gov
(212) 616-2321
Region III (Delaware, District of Columbia, Maryland, Pennsylvania,
Virginia, West Virginia)
Rina Kelley
rina.kelley@cms.hhs.gov
(215) 861-4186
Region IV (Alabama, Florida, Georgia, Kentucky, Mississippi, North
Carolina, South Carolina, and Tennessee)
Denise Stanley
denise.stanley@cms.hhs.gov
(404) 562-7366
Region V (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin)
Greg Dill
gregory.dill@cms.hhs.gov
(312) 353-1754
Region VI (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas)
Gary Blair
gary.blair@cms.hhs.gov
(214) 767-4438
Region VII (Iowa, Kansas, Missouri, and Nebraska)
Tammy Twait
tammy.twait@cms.hhs.gov
(816) 426-6552
Region VIII (Colorado, Montana, North Dakota, South Dakota, Utah,
and Wyoming)
Gary Pulvermacher
gary.pulvermacher@cms.hhs.gov
(303) 844-2760
Region IX (Arizona, California, Hawaii, and Nevada; Territories
of American Samoa, Guam, and the Commonwealth of the Northern Mariana
Islands)
Lucy Saldaña
lucy.saldana@cms.hhs.gov
(415) 744-3625
Region X (Alaska, Idaho, Oregon, and Washington)
Jo Wyeth
jo.wyeth@cms.hhs.gov
(206) 615-2430
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