As you know, the Centers for Medicare & Medicaid Services (CMS) has been very engaged in the implementation of the Medicare prescription drug benefit. In the first 10 days of the new benefit, nearly 10 million prescriptions have been filled and hundreds of thousands of beneficiaries have enjoyed significant savings at the pharmacy counter as they use this new benefit. CMS is very focused on a number of implementation issues. In particular, we are concerned about the number of dual eligible beneficiaries who appear to be having difficulties obtaining their needed prescriptions. This Hill Notification provides an update and describes a number of actions that CMS has undertaken to address this particular issue as well as other issues that have arisen since January 1. The first download, “A Summary of CMS Actions on Medicare Prescription Drug Benefit”, is an overview of recent CMS actions. One of CMS's major concerns is prescription drug plans' proper implementation of transition policies to ensure that no one will ever leave the pharmacy counter without his/her needed medications. In March 2005, CMS sent out guidance to the prescription drug plans on what elements should be included in their transition plans. The plans submitted their plans to CMS and all of them were approved in the Fall of 2005. The second download is a spread sheet titled “PDP Transition Policy 12-28-2005,” which lists the transition policy of every plan. CMS has sent a series of letters in January to the plans to remind them of their responsibilities under their transition plans. On January 4th, CMS notified plans of the need to increase capacity on their help lines, and on January 6th, CMS reminded them that their transition policies must be applied consistently. Please see the downloads titled “Information to Assist Pharmacists in Completing Pharmacy Transactions” and “Pharmacy Transition Policies” for more information. On January 13th, CMS sent two letters to plans that further reinforced formulary transition policies and cost sharing procedures for dual eligible beneficiaries. Please see the related downloads titled “Expedited Processes for Application of Cost Sharing for Dually Eligible and Other Low-Income Beneficiaries” and “Further Clarification of Formulary Transition Policies” for more information. In addition to these letters to the prescription drug plans, CMS also sent a letter on Friday evening, January 13, to its many partners in the implementation of the drug benefit to provide them an update on recent CMS actions. Please see the download titled “January 13, 2006 Partner Letter” for more information. Finally, on Saturday, January 14, CMS sent additional guidance on the coordination of benefits to the State Medicaid Agencies and the Governors' offices. Recognizing that certain states have instituted programs to assist dual eligible individuals who were having problems at the pharmacy counters, this guidance advises states on how to minimize the issues of reconciling payments between states and prescription drug plans. For more information, please see the download titled “Guidance to States Transitional State-Part D Plan Coordination of Benefits 01.14.2005.” | 
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