Medicare’s highest priority is making sure that Part D beneficiaries have access to the drugs they need. Millions of prescriptions are being filled every day, with Medicare drug plans generally covering a broader range of drugs than many public and private health insurance plans.

Medicare drug plans have preferred drugs and prior authorization requirements to promote safe and effective drug use and to avoid unnecessary costs. To help ensure smooth transitions to drugs that are covered, and to allow beneficiaries time to obtain exceptions to these requirements when clinically appropriate, Medicare called on plans to implement a three-month initial transitional period for Medicare prescription drug coverage.

While that transition period is ending, Medicare’s requirement that prescription drug plans have an effective transition process is permanent. This requirement continues to apply for beneficiaries who did not complete the transition process during the 90-day transition period.

First and foremost, at all times, Part D plans have an important role in communicating with their enrollees and informing them about what they need to do to make a successful transition. They also need to make timely decisions on enrollees’ requests for exceptions and appeals.

Medicare Part D enrollees should not have to learn at the pharmacy counter about their need to obtain prior authorization for a drug or transition to a different drug, nor should they face delays at the pharmacy counter because exceptions requests have not been resolved.

Throughout the transition period, CMS has repeatedly corresponded with plans outlining their role in assisting beneficiaries in this transition .

CMS Medicare Prescription Drug Coverage: Getting Drugs After Your Transition Period 1 Page(s) / 43.22 Kb - Download time approximately 12.6 secs on a 28.8k connection Adobe Acrobat - Download a viewer for this attachment - How to Download

Beginning January 1, 2006, Medicare Part D takes the place of current Medicaid prescription drug coverage for people who have both Medicare and Medicaid. Listed below are resources to help with your Medicare Part D implementation.

Hospitals experiencing problems with Medicare Part D implementation should contact Melissa Dehoff, HAP director of health care continuum finance policy, at (717) 561-5318.

Medicare Part D Program Frequently Asked Questions 4 Page(s) / 151.03 Kb - Download time approximately 44.2 secs on a 28.8k connection Adobe Acrobat - Download a viewer for this attachment - How to Download