December 2, 2005

Answers to Frequently Asked Medicare Part D Questions
Part III

Medicare Part D Initial Sign-up Period

The initial sign-up period for Medicare Part D is from November 15, 2005, through May 15, 2006.  If an eligible person does not enroll in a Medicare plan by May 15, 2006, he/she must wait until November 15, 2006, to enroll with an effective date of January 1, 2007.  Therefore, if this patient’s situation in regards to prescription usage and costs changes after May 15, 2005, he/she cannot have drug coverage under Medicare Part D until January 1, 2007.

I.V. Medications for Nursing Home Patients

With Medicare Part D having several requirements for pharmacies providing medications to long term care residents, many pharmacists have subcontracted with other providers to provide some services, most notably I.V. medications.  We have been informed that some pharmacists have turned to local hospitals for those services.  Be informed that in-patient hospital pharmacies do not have a retail pharmacy permit and cannot supply prescriptions to outpatients who are not employees for the hospital under State Board regulations.

Community Care Rx Enrollers

Previously, CCRx enrollers were not paid a commission for enrolling Medicare beneficiaries into the Basic Plan. That policy for CCRx enrollers has changed.  Enrollers now can be paid sign-up fees for enrolling patients in the CCRx Basic Plan.  All Medicaid dual-eligible patients should be signed up in the Basic Plan.  This plan may be best for a few other patients as well.

Generic Co-Pays for CCRx Basic plan

CCRx charges no co-pay for generic drugs in their Basic Plan.  However, CMS has informed CCRx that there must be the $1.00 generic co-pay collected during the deductible period (the first $250 in prescription costs) and during the coverage gap (“donut hole”; $2250 to $5100 in prescription costs).  CMS computers will handle this issue, and the pharmacist will be informed of when to collect a co-pay upon adjudication of the prescription.

Arkansas Community Care, Inc.

Please be aware that for Lonoke, Pulaski, Saline, White, Benton, Carroll, Madison, and Washington Counties, a Medicare plan named Arkansas Community Care, Inc. is available for Medicare beneficiaries.  This plan is not Community Care Rx.

Performance and Service Criteria for Network LTC Pharmacies

Several members have inquired about the definitions of performance and service criteria that must be met by network LTC pharmacies.  That list of criteria and definitions are available on the Medicare Madness Page of the APA website (www.arpharmacists.org).

Medicare’s Website and the Plans Your Pharmacy Accepts

On Medicare.gov, beneficiaries can research which plans their pharmacist accepts.  APA has been notified that this website gives incorrect listings of accepted plans.  APA advises you to check your pharmacy’s listing on Medicare.gov.  If incorrect information is given, notify Medicare immediately.

CCRx Operators

APA has been notified that when a dual-eligible patient calls CCRx to enroll in the basic plan, the operator does not ask the patient if he/she is a dual-eligible.  Therefore, dual-eligible patients are told they will have a deductible and monthly premiums, which do not apply to these patients for the Basic Plan.  If a dual-eligible patient is planning to enroll in the CCRx Basic Plan by phone, advise your patient to tell the operator that he/she is a dual-eligible.