1	WHAT YOU NEED TO KNOW ABOUT MEDICARE PART D Pharmacy Outreach Program University of Rhode Island College of Pharmacy
2	MEDICARE Medicare provides health insurance for… Aged 65 years or older Aged 65 years or less with certain disabilities All people with End-Stage Renal Disease (ESRD) All people with Lou Gehrig’s Disease (ALS)
3	THE PARTS OF MEDICARE Part A Hospital insurance Part B Medical insurance Medicare Advantage Plans Part D Prescription drug coverage
4	MEDICARE PART D Stand-alone prescription drug coverage Open to all people eligible for Medicare Open enrollment begins November 15, 2007 Enrollment for coverage of the year 2008 ends on December 31, 2007 Coverage Begins on January 1^st, 2008 Medicare Part D is VOLUNTARY!!
5	Medicare Advantage Health insurance coverage, including preventative care PLUS prescription drug coverage in a single plan In exchange, typically must use a certain network of doctors, hospitals, and pharmacies
6	Medicare Advantage Of the 13 plans, 2 will provide some coverage for the gap, 11 will not **If you already have a Medicare Advantage plan and you want to add drug coverage you MUST obtain it through your Medicare Advantage provider. If you obtain an independent standalone drug plan instead, your health coverage under the Medicare Advantage plan will stop.
7	WHEN CAN I RE-ENROLL? Re-enrollment begins November 15^th, 2007! Your new plan will take effect January 1^st, 2008 If you are happy with your current part D plan, you don’t need to do anything during the re-enrollment period! Your Med D plan will automatically re-enroll you But be aware::::: your premiums, co-pays, formulary, or deductible may be changed for the new year!
8	Enrollment Info Open enrollment is from Nov.15-Dec 31st of each year Coverage begins on January 1, 2008 If you become eligible for Medicare Part D after the enrollment period, you have a 7 month period to enroll without incurring a penalty 3 months before, the month of and 3 months after the month of your 65^th birthday
9	Who Should Apply? Enrolled in a Med D plan right now, but thinking about switching to another plan next year You didn’t sign up for a plan when eligible last time around but you’re thinking of enrolling now Penalty for every month without coverage Enrolled in a Medicare Advantage Plan or Medigap Supplemental Insurance Plan but you want to add or change your drug coverage
10	Who Doesn’t Need To Apply If you have CREDITABLE Coverage: This means that you already are enrolled in a plan that provides a prescription drug benefit that is EQUIVALENT or better than that being offered through Medicare Part D You would have already been made aware of this by your insurance provider by mail KEEP THIS LETTER IN A SAFE PLACE If you are unsure if your coverage is creditable or not, ask your employer or union for it!**
11	Penalty Info If you did not enroll but were eligible to do so, when you enroll now for coverage beginning on Jan.1,2008- you will incur a penalty of 1% per month of average premium Will have to wait until Nov 15- Dec 31, 2008 to join a Medicare drug plan if don’t do so now! Average premium 2008 = $28.00 1% of $28 = $0.28 12 months penalty= $3.36 Therefore, $3.36 will be added unto your monthly premium every month forever!
12	Penalty Info You will not have this penalty enforced: If you were not previously eligible for Medicare Part D If you previously did had creditable coverage
13	HOW PART D WORKS Remember::: this is just an explanation of the template used as a general basis for the plans --there are options! STANDARD PLAN (2008) $28 per month premium ($336/year) $275 deductible 75% coverage from $275 to $2510 NO coverage from $2510 to $5726.25 This is called the “Donut Hole” 95% coverage beyond $5726.25 Equivalent to $4050 dollars out of pocket spending
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15	Think of it as Steps! Step #1 – The Deductible You pay 100% and plan pays 0% You receive $275 worth of medications Step #2 – Co-insurance You pay 25% ($558.75) and plan pays 75% ($1676.25) You receive $2235 worth of medications (Total: Step 1 + Step 2 = $2510)
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17	Think of it as Steps! Step #3 – The Donut Hole You pay 100% and plan pays 0% You receive $3216.25 worth of medications Total: Step 1 + Step 2 + Step 3 = $5726.25 Step #4 – Catastrophic Coverage You pay 5% and plan pays 95% You receive unlimited drugs for the remainder of calendar year
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19	Remember! Even though you were enrolled in a program last year, you start from the Step #1 all over again on January 1, 2008 You will continue to pay the premium every month regardless of what step that you are on Even when in the “donut hole” a person still pays the monthly premium!
20	Besides Standard Plan… Must offer basic/standard drug benefit May offer enhanced benefit Some have no deductible Some have help during “donut hole” (coverage gap) The Premium depends on the enhancements Mail order options may save costs on maintenance medications (90 days)
21	How Do I Choose The Right Plan? Rx Enrollment Check-Up: Cost Will your premium and costs change in 2008? Coverage Will you need more comprehensive coverage? Will your current meds be covered by your plan? Customer Service Are you satisfied with your service from your current plan?
22	Important If you decide that your current Med D plan will meet your needs in 2008 then you do not need to re-enroll Coverage will continue through 2008 starting from Step 1
23	Plans Available in RI for 2008 Total of 25 companies offering 51 plans 31 plans available with NO deductible! 2 plans with monthly premiums less than $20 The lowest monthly premium is $14.60 15 plans will provide coverage during the “donut hole” 14 plans available for those with low income subsidies
24	HOW PART D WORKS Formulary system Each plan selects certain drugs from each drug class that they will cover May have a tier system May have up to 5 tiers Generic drugs = cheapest (ex: $5) Preferred brand names = more expensive (ex: $28) Non-preferred brand names = most expensive (ex: $40) Certain injectable and specialty drugs= highest tiers (ex: $58)
25	DEFINITIONS: New terms: Generics: will be required to be covered by ALL plans Prior authorization: may be needed for some medications Appeal process mandated by insurance company which includes paperwork involving the MD Step Therapy: may be required before certain medications will be covered ex: Prilosec before Nexium or Motrin before Celebrex Quantity limits: may be enforced 30 day quantities retail vs. 90 day mail-order Some plans DO allow 90 day quantities of maintenance medicines at community pharmacies.
26	Frequently Asked Questions
27	WHAT ABOUT MY RIPAE? You SHOULD keep your RIPAE! It will provide coverage throughout the deductible and coverage gap BUT, it is not creditable coverage You need a Medicare Part D Plan too See your SHIP counselor or call The Point for RIPAE information
28	RIPAE… Provides extra benefit for those who don’t qualify for extra help from Medicare Applicable to all expenses that person is 100% responsible for Deductible Coverage gap (“Donut Hole”) Drugs not covered under your Part D Plan Only certain ones!
29	RIPAE… Eligible: Single, income less than $42,493 per year Married, income less than $48,563 per year The lower the financial category, the higher percentage RIPAE will pay More information 401-462-4444 – The Point Wrong phone number on Medicare and You 2008 Booklet! Talk to SHIP counselor
30	What about my Tricare, VA, Pension Benefits? They are creditable coverage, letters have have been mailed! Hold on to these letters! Contact your pension benefits manager or union if you have any questions
31	Dual Eligibles (Medicare/Medicaid) Will automatically be eligible for: No premium No deductible No donut hole Minimum co-payments ($1.05 generic & $3.10 brand) Have been automatically enrolled in a plan & will be automatically re-enrolled in a plan Part D plan for 2008 won’t necessarily be the same plan as 2007 due to cost restraints! Reassignment notices will be sent out 10/30/07 Enrollment confirmations will be sent 12/1/07 If you are “dually eligible,” you can change your plan at any time during the year! Once per month!
32	What is Extra Help (LIS)? FPL determined by government each year Best to apply and be formally denied Many deductions so apply! No deductible and no donut hole!!! RI has 2 plans for less than $20/month for 2008 The plan with the lowest monthly premium for our area is $14.60 and is First Health Part D-Secure Targeting those on a tight income yet do not meet the above requirements
33	“Deemed” Population Defined as those who had Low Income Subsidy (LIS) for 2007 and are not automatically eligible for 2008 Notifications have been sent out with applications to re-enroll Does not mean that you are not eligible Reapply!!!
34	Ways to Lower Your Drug Costs During the Coverage Gap Ask your doctor about generic and less expensive brand name drugs (therapeutic substitutions) Cheaper in the gap Less likely to hit the gap if avoid brand names from the beginning Ask your doctor for samples National & Community Based Charitable Programs For specialty drugs Pharmaceutical Assistance Programs Available from the pharmaceutical manufacturers Contact the Partnership for Prescription Assistance 1-888-477-2669
35	Ways to Lower Your Drug Costs During the Coverage Gap State Pharmaceutical Assistance Programs RIPAE Based on your income, RIPAE will pay 15%, 30%, or 60% of drug cost during coverage gap Apply for Extra Help If you have limited income and resources, you may qualify for extra help For more information go to www.socialsecurity.gov or call 1-800-772-1213
36	What if I like a plan and one of my drugs is not covered? Options: Ask your pharmacist about therapeutic substitution Compare prescription vs. over the counter options Nexium $158.00 Prilosec OTC $21.99 Omeprazole Rx- lowest cost or co-pay Always consult with your doctor regarding changes to your medications
37	Drugs that are Not Covered by ANY Part D Plan Can still get these drugs but must pay the retail price (“cash”) and it does not count towards out of pocket expenses or total drug costs Examples: Benzodiazepines alprazolam, lorazepam, diazepam Drugs for weight loss, hair loss, and fertility Drugs covered under Medicare parts A and B Example: Drugs received while in the hospital, diabetic testing supplies
38	Using the Internet Get a complete list of your medications and the cash price from the pharmacy Be sure to include all prescriptions-eye drops, creams, inhalers, patches, etc. Go to www.Medicare.gov and click on “Formulary Finder” Follow the prompts and enter your medications Can also call 1-800-MEDICARE (1-800-633-4227) Can enroll on line—have your Medicare card ready CVS and Walgreens both have websites to condense your search of possible plans
39	Important Dates to Remember October- Compare and Prepare November 15- Open Enrollment Begins December 8- Don’t Be Late December 31- Open Enrollment Ends January 1, 2008- Coverage Begins *Next Open Enrollment Period is not until November 15- December 31, 2008*
40	In summary…. No single plan is best for everyone You must pick the plan that’s right for YOU! Yes, it is confusing, so don’t be afraid to ask for help: The Point!!! (401) 462-4444 SHIP counselors at your local Senior Center Dept. of Elderly affairs (401) 462-4000 Ask a relative or friend to help you navigate the Web Social Security Administration 1-800-772-1213 Pharmacy Outreach Program 1-800-215-9001 www.uri.edu/pharmacy/outreach
41	"THANK YOU" THANK YOU!