Medicare Information for Pharmacists

Information Pharmacists Can Use on Closing the Coverage Gap

Beginning in January, 2011, people with Medicare who have Part D, but don’t get Extra Help (the low-income subsidy), will get a 50% discount under the Medicare Coverage Gap Discount Program on “applicable” drugs at the point-of-sale and a 7% increase in coverage for all other covered Part D drugs (e.g., generic drugs and supplies associated with the delivery of insulin) while they are in the coverage gap. Over the next 10 years, prescription drug coverage will continue to increase for all covered drugs in the coverage gap so what people pay during the gap will continue to decrease until it reaches 25% in 2020.

CMS has provided a tip sheet (click here) with background on the Coverage Gap Discount Program to assist pharmacists in answering beneficiary questions. This tip sheet provides information about which drugs are eligible for a 50% discount, including a link for participating labeler codes, an example of how the discount will be applied by Part D Plans at the point of sale, tips for pharmacists preparing for the launch of the discount program, and more background on questions that pharmacists may be asked by Medicare beneficiaries.

Pharmacists may e-mail PartD_NDC@cms.hhs.gov with questions about the implementation of the Coverage Gap Discount Program.

CMS Releases Proposed Rules For Plan Year 2012 Related to the Medicare Advantage and Prescription Drug Benefit Programs…

CMS has published to the Federal Register a notice of proposed rulemaking to implement provisions of the Affordable Care Act related to the MA and Prescription Drug Benefit Programs. This proposed rule also sets forth programmatic and operational changes to these programs for contract year 2012 based on continued experience with the administration of the Parts C and D benefits. Provisions included in this proposed rule fall into the following five categories:

• Implementing provisions of the Affordable Care Act;
• Clarifying various program participation requirements;
• Strengthening beneficiary protections;
• Strengthening Medicare’s ability to distinguish stronger health plans for participation in Medicare Parts C and D and to remove consistently poor performers; and
• Implementing other clarifications and technical changes.

The proposed rule has a 60-day public comment period with the final rule scheduled to publish in early spring 2011 to allow appropriate timing for the 2012 contract year bids.

A copy of the regulation may be viewed at the Federal Register’s website, www.ofr.gov/inspection.aspx.