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July 2008 Medicare Part D Newsletter
:: 1. Changing your Primary Residence and the Residency Update Form
:: 2. New Feature: 2008 Prescription Drug Plan Enrollment Figures Now Online
:: 3. Dealing with the “Off-Label" Medication Dilemma
:: 4. More Retail Stores Offering Prescription Drug Discounts
:: 5. Closing Notes
1. Changing your Primary Residence and the Residency Update Form
The first item in this month’s Newsletter has two important parts. First, is a reminder about changing your primary address while enrolled in a Medicare Part D prescription drug plan. Plus, we have also included an important warning about a “Residency Update Form" that may appear in your mail.
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The Reminder
Looking to move to another part of the country? When you change your primary address by moving from one Medicare prescription drug plan region (or PDP region) to another, you are granted a Special Enrollment Period (or SEP) to change from your current Part D plan to another Part D plan that is available in your new Medicare Part D region – this SEP is in addition to your normal Annual Enrollment Period (AEP or Annual Coordinated Election Period) that runs from November 15 until December 31 of each year.
So you may be asking: “What is a Medicare PDP region compared to an actual state?" Medicare Part D prescription drug plans (PDPs) are offered in 39 regions or geographic areas designated by the Centers for Medicare and Medicaid Services (CMS). CMS established 34 PDP regions consisting of the 50 states and the District of Columbia, as well as 5 separate PDP Regions for the United States territories. Therefore, not every single state is its own separate Medicare PDP region. Instead, some states are combined together to form a larger Medicare PDP region. For instance, PDP Region 11 consists of only the state of Florida, whereas PDP Region 6 is made up of both Pennsylvania and West Virginia.
The key to remember is that, even if you move to another state, you may still be in the same Medicare PDP region and you will not need to (or be allowed to) join another Medicare Part D prescription drug plan. As an example, if you were to move from West Virginia to Pennsylvania, you will not be granted a Special Enrollment Period. However, if you were to move from Florida to Pennsylvania, you will be granted a Special Enrollment Period to select a new Part D plan.
We have a list of Medicare PDP regions online that you can use as reference, along with state links to information on some of the national Medicare Part D plans available in the different PDP regions – this should give you an idea of how Part D plans can vary from PDP region to PDP region: http://www.medicare-partd.com/PartD-Medicare-PartD-Overview-byRegion.php.
Do you wish to learn more about the Special Enrollment Period granted to those people who change their primary residence to another Medicare PDP region outside of the Annual Enrollment Period? Click here for more information on this Special Enrollment Period.
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Now … The Warning!!
So why are we providing all of the information on moving to a new PDP Region?
We recently learned that some Medicare Part D prescription drug plan members were disenrolled from their Medicare Part D plan because the Members did not return a Residency Update Form that was mailed out by their Part D plan provider. The form was intended for Part D plan Members who moved to a new PDP region and were now considered as “Out of Service Area" participants.
If you have received a Residency Update Form (or the like) from your Medicare Part D plan asking you to update or confirm your primary address, please be sure to complete and return it promptly to your Part D plan provider.
If you find that your Medicare Part D plan has suddenly ended (for instance, you have received a letter regarding disenrollment), be sure to contact your Part D plan immediately to determine the cause of your prescription drug plan termination (the telephone number for Member Services should be on the back of your Part D Member ID card).
You may find that, although you have not changed your primary residence, your Part D plan did not receive your Residency Update Form and terminated your Part D coverage.
Need additional help? Click here for our Customer Help Desk
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2. New Feature: 2008 Prescription Drug Plan Enrollment Figures Now Online
Wondering how your Medicare Part D prescription drug plan works with the medication coverage provided under your Medicare Part A or Medicare Part B?
We now have the 2008 Medicare Part D prescription drug plan enrollment figures online as a new addition to our Medicare-PartD.com 2008 PDP-Finder tool.
So if you are wondering how many other Medicare beneficiaries also enrolled in your 2008 Medicare Part D plan, you can go to our free online tool, choose your state, enter the name of your Part D plan (partial Part D plan names also work), and see the 2008 enrollment figures per prescription drug plan per CMS Region, plus, the average PDP enrollment across all CMS regions, and the total enrollment across the country.
Interested in seeing which 2008 Part D plan was the most popular in California (or any other area)? Go to the PDP-Finder, choose California as your state, and sort the results by “State Enrollment Highest to Lowest" – Click here to see this example already completed.
Any feedback or questions? Click here to let us know.
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3. Dealing with the “Off-Label" Medication Dilemma
Over the past few months, we have been hearing from Medicare beneficiaries who are using certain “off- label" prescription medications and asking about how to get Part D coverage for these drugs. The term “off–label" refers to drugs that are being used to treat conditions other than those approved by the Federal Drug Administration (FDA). For instance, some pain relief medication is approved by the FDA for cancer-related pain, but is not approved by the FDA for Medicare beneficiaries who have non-cancer related pain. Therefore, such a medication would be considered “off-label" if it was used to treat non-cancer related pain.
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Why is this topic so important?
Over the past few months, we have been hearing from Medicare beneficiaries who are using certain “off- label" prescription medications and asking about how to get Part D coverage for these drugs. The term “off–label" refers to drugs that are being used to treat conditions other than those approved by the Federal Drug Administration (FDA). For instance, some pain relief medication is approved by the FDA for cancer-related pain, but is not approved by the FDA for Medicare beneficiaries who have non-cancer related pain. Therefore, such a medication would be considered “off-label" if it was used to treat non-cancer related pain.
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How widespread is the use of “off-label" medications?
In a recent article from the Baltimore Sun, it was suggested that more than 20% of the 725 million prescriptions written for the 500 most common medications prescribed in the United States are being used as off-label medications. That is, these medications are being used to treat conditions outside of their FDA approved use.
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So what to do if you are using an “off-label" Medication?
If indeed your Medicare Part D prescription drug plan considers an off-label medication as a "non-formulary" drug, your first step is to work with your physician to find an effective alternative that is covered under your Part D plan formulary.
If an alternative drug is not available, the next step is for you to submit your off-label medication to your prescription drug plan’s formulary-exception process for inclusion under your Part D coverage. In other words, you will ask that your Part D plan include this medication into your personal covered drug list. When in doubt as to the procedure, contact your Part D plan’s Member Services department.
In general, the formulary exception process will take a bit of time and effort, but the possibility exists to get otherwise excluded medications under the coverage of a Part D plan. Be sure to ask for assistance from your attending doctor(s). As many physicians know, there is a "medically accepted indication" exclusion that the Medicare law provides stating that if any published evidence can be shown that the medication helps a particular condition, it should be considered during the formulary exception process. Usually, this means that there is some information on the "off-label" use of a medication in the major drug compendia (or major drug encyclopedias).
Would you like to read more and add your comments to this article? Click here for our Blog.
Still not sure where to begin or you have a question? Click here to let us know.
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4. More Retail Stores Offering Prescription Drug Discounts
We are now, once again, in the Doughnut Hole season or the time of year when many people with higher prescription costs will begin to enter the 2008 Coverage Gap portion of their Medicare Part D coverage.
However, there is more good news for prescription drug bargain hunters. In our last Newsletter we noted that both Wal-Mart and Target announced that they would expand their low-priced prescription drug pricing program. Now Safeway reported that they will also expand their generic medication program in the eastern United States, offering $4 prescriptions for hundreds of generic medications. Kmart also recently announced that it will reduce prescription prices and expand its generic prescription drug program to include more than 500 medications. Currently, Kmart noted that it offers over 100 generic medications for $5 a prescription and a three-month supply of common medications for $10.
Not sure which drugs are covered? Click here to download the discount drug lists provided by Kmart, Kroger, Target, Walgreens, and Wal-Mart.
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Beth, a New York Health Insurance Information and Assistance program volunteer from Harpursville, New York suggests that Medicare beneficiary compile a list of discounted medications available in their area (from Sams Club, WalMart, Target, or other sources) and then take their list(s) to their doctor and determine what generics can be substituted for their present brand name medications. Not only was Beth able to find lower cost generics for her own needs, but more importantly, Beth’s doctor actually was able to use Beth’s well organized list to help many other patients find lower-priced medication.
Would you like to submit a list of discounted medications for inclusion on our website? Click here to submit your list.
Wondering when you may enter the Coverage Gap or Doughnut Hole? We have an online tool that may help.
Here is a link to our 2008 PDP-Planner: http://www.medicare-partd.com/PartD-PartDCoverageGapCalculator08Xphp.php
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Senior Groups, Organizations, Nursing Homes and Health Care Providers: Please let us know if you would like to have information about your Organization, Facility or
Company listed on our site www.Medicare-PartD.com. Click
here for the link to our Group and Company Contact Form. We encourage you to link to our website.
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Last updated on: 11/14/2008
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