Senior Sentry - June 2009

ConnPACE and Connecticut Medicaid recipients: Please be aware that as of June 1, 2009 no new prescriptions for non-formulary drugs will be covered under the ConnPACE or Connecticut Medicaid program; regardless of the Medicare Part D plan you have chosen. Only prescriptions for non-formulary drugs written prior to June 1, 2009 will continue to be covered. FORMULARY AND NON-FORMULARY: What’s the difference? What is a formulary drug? Formularies are a list of prescription drugs, both generic and brand name, that are available through your health plan. The purpose of your health plan’s formulary is to steer you to the least costly medications that are sufficiently effective for treating your health condition. What is a non-formulary drug? A non-formulary drug is a medication that has a preferred alternative listed in the drug formulary. It's not on the list of approved medications through your health plan. What is a generic drug? A generic drug is produced and sold under the chemical name and approved by the Food and Drug Administration (FDA) to be therapeutically equivalent to the brand-name drug. Generic drugs must contain the same active ingredients in the same amounts as their brand-name counterparts.

Changes to Prescription Coverage

I just received a letter dated 5/21/09 from the Department, what does it mean?

The State of Connecticut needs to reduce expenses due to the current state of the economy. Therefore, it has decided that it will no longer be paying for any newly prescribed medications that are not covered by your Medicare Part D Plan’s formulary* (these are known as ‘non-formulary’ drugs).

What if I am prescribed a medication after June 1, 2009 that is not on my Medicare Drug Plan’s formulary? What do I do?

You should ask your pharmacist to contact your prescriber to discuss other medications that are available on your Medicare Drug Plan’s formulary. Your prescriber should work with your Medicare Part D plan as well to discuss options.

Your prescriber may either change your prescription to a drug that is covered by your Medicare Part D Plan, or he/she may ask your Medicare Part D Plan to grant an exception or authorization so that the drug will be covered by the Medicare Part D Plan. If it is medically necessary for you to receive the specific drug that is not covered by your Medicare Part D Plan, your prescriber must ask for this exception or authorization from your Medicare Part D Plan.You are urged to work within your Medicare Drug Plan’s formulary.

What if I have to take this particular medication due to my medical condition?

If it is medically necessary for you to receive the specific drug that is not covered by your Medicare Part D Plan, your prescriber must ask for this exception or authorization from your Medicare Part D Plan. Please have your prescriber contact your Medicare Part D Plan directly. If your prescriber needs assistance, he/she can contact the Department’s Pharmacy Technicians at the numbers provided in your letter.

What if my prescriber and/or pharmacist have questions? Where can they turn for help?

The Department of Social Services will continue to work with pharmacies and prescribers to help answer their questions about your Medicare Drug Plan. Please consult your letter, there are two numbers for the Department’s Pharmacy Unit that your pharmacy or provider may use for assistance.

860.424.4880, or toll free, 1.800.340.0715

Is this a permanent change?

This change will be in effect until the remainder of the State’s current fiscal year [June 30, 2009], if the budget passes after the end of the fiscal year. Depending on final budget, the new policy may or may not be changed. If any changes are made after the budget passes, you will receive another letter with more information.

When the final budget is passed and if there are changes to this decision, or other changes made to the pharmacy program, how will I learn about them?

If any changes are made after the budget passes, to either this decision or to any other coverage changes, you will receive another letter with more information.

Is it possible for me to switch Medicare Part D Plans to one that has a formulary that covers my medications?

It may be possible for you to switch Medicare Part D Plans at this time. You may call CHOICES at 1.800.994.9422, and they will help you by comparing your current medications to the formularies of different Part D Plans and determining whether you are qualified to change plans at the given time. Your pharmacist may be able to assist you in researching another Medicare Drug Plan as well.

Will the Department help identify and/or enroll me in another Medicare Drug Plan?

You may call CHOICES at 1.866.994.9422, and they will help you by comparing your current medications to the formularies of different Part D Plans. Your pharmacist may be able to assist you in researching another Medicare Drug Plan as well.