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May 2008 Medicare Part D Newsletter (with corrections from June 3, 2008 Newsletter Update)
:: 1. New Medicare-PartD.com Site Feature – Online Drug Search
:: 2. Comparing Drug Coverage Under Medicare Parts A, B, C, and D
:: 3. Who Pays First? Coordinating Your Part D Benefits with Other Programs
:: 4. Using Your Medicare Part D Prescription Drug Plan with Store Discounts
:: 5. Press Release – Voluntary National Recall of Digitek®
:: 6. Closing Notes
1. New Medicare-PartD.com Site Feature – Online Drug Search
Looking for an easy way to find more information on prescription or over-the-counter medications? The newest addition to the Medicare-PartD.com website is an
online drug search. Users of the tool can search alphabetically by medication name or browse through a
list of the top 200 drugs. Medications include brand name prescription drugs, generics, and even some over-the-counter and herbal remedies. When you click on one of the medication names, a new window is opened and you are taken to RxList.com providing additional drug information including, alternatives, precautions, and side effects of your chosen drug. Is your prescription medication not found on our list? No problem,
click here to send us a note and we will update our list for your future use. The features of our drug search will be expanding throughout the year so stop back and don’t forget to
send us an eMail with your suggestions for new features.
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2. Comparing Drug Coverage Under Medicare Parts A, B, C, and D
Wondering how your Medicare Part D prescription drug plan works with the medication coverage provided under your Medicare Part A or Medicare Part B?
- In general, your Medicare Part A (hospitalization) covers medications that are administered during your hospital or nursing facility visit (as noted by the Medicare Rights Center website, if the nursing facility medication is not covered by Part A, then it will be covered by Part D).
- Your optional Medicare Part B (physician services) covers medications administered in your doctor’s office and a limited number of drugs administered as an outpatient.
- In general, your Medicare Part D plan covers medications that are taken as an outpatient that were prescribed by your doctor and provided by a pharmacy.
- As many people have learned, some prescription medications are simply not covered by the Medicare Part D program. Drugs excluded from the Medicare Part D plans include some anti-anxiety and anti-seizure drugs, most prescription vitamins and minerals, and drugs used for anorexia, weight loss or weight gain; fertility; cosmetic purposes or hair growth; or relief from symptoms of colds. Here is a more extensive list of excluded medications
provided by the Centers for Medicare and Medicaid Services (CMS).
- Also, there are some prescription medications that could be covered by Medicare Part B or Medicare Part D prescription drug plans, depending on the situation.
Click here to view a list of different situations where Medicare Part B or Medicare Part D plans cover a given medication.
- Are drugs covered by a Medicare Advantage plan? A Medicare Part C or Medicare Advantage plan may cover all the medications covered together by Medicare A, Medicare B, and Medicare D – however, coverage varies from plan-to-plan and you should be certain that you understand the prescription coverage of a Medicare Advantage plan before joining. Some Medicare Advantage plans can even reduce the amount of medication coverage that you would normally receive under, for example, original Medicare Part B.
- Are drugs covered by a Medicare Supplement? A Plan H, I, or J Medicare Supplement policy or Medi-Gap policy issued after January 1, 2006 does not cover any prescription drugs – however, some older Medicare Supplements may still have a prescription drug benefit and can be renewed by the policy holders. If you decide to purchase a new Medicare Supplement policy, you may also wish to enroll in a Medicare Part D plan for your prescription drug coverage.
- What about medications not covered by your Part D plan and are outside of your Part A and Part B coverage? If you are already using the medication, you can work with your Part D plan to receive a transition supply of medication while you seek an alternative medication covered by your Part D plan – and/or you can request an exception to your plan’s formulary or drug list. The key is not to wait, but to get working with your physician and Part D plan administrator as soon as you see the need to ask for an exception.
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3. Who Pays First? Coordinating Your Part D Benefits with Other Programs
Aside from Medicare Part A, Part B, and Part C, some people are not certain how their Medicare Part D prescription drug benefit coordinates with their other prescription drug programs. The Centers for Medicare and Medicaid Services (CMS) has released a few example of how Medicare beneficiaries can work through their benefit coordination.
For example, what if you are in an automobile accident and you have no-fault or liability coverage? CMS notes that in such a situation, “[i]f the beneficiary was injured or fell ill and has no-fault or liability coverage (such as when you are in a car accident), the no-fault or liability coverage is primary to Part D for all drugs that are related to that injury or illness. Therefore, the no-fault/liability coverage will be billed for all such drugs first, and the Part D plan will be billed second."
Or, as another example, what if a Medicare beneficiary is also covered under their state’s Medicaid program (like Medi-Cal in California)? In such a situation, CMS provides that, “Medicaid only pays for drugs for Part D beneficiaries when those drugs are not allowed to be covered by Part D. Therefore, people who are covered under both Part D and Medicaid will never have drugs that are paid for by both types of coverage. Either the Part D plan will pay, or Medicaid will [pay]."
Click here to see more examples of how prescription benefits coordinate with SPAPs or Group Health Plans.
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4. Using Your Medicare Part D Prescription Drug Plan with Store Discounts
Good news for prescription drug bargain hunters. Earlier this month both WalMart and Target announced that they would expand their low-priced prescription drug pricing program to include selected 90 day supplies of over 350 generic medications at the price of $10. WalMart will also offer discounts on generic drugs used by their female customers including: Alendronate and Tamoxifen.
So what do you do if your Medicare Part D plan has a co-payment rate for generic drugs that is higher than the prices offered by such retailers as Walmart and Target?
As long as you are not in the coverage gap (or doughnut hole), you should pay the lesser of the two costs when using your Medicare Part D plan. In other words, if your usual Part D plan co-payment is $7 and the lower discounted retail price is $4, you will be charged the lower price of $4.
Some Part D plans also noted that you may save even more money on larger prescription orders when using your Part D plan at discount pharmacies. For instance, if you have a prescription for a 30-day supply of 90-pills (3 pills per day), your Part D plan’s co-payment may be based on your actual prescription and not the quantity of pills. However, some discounted retail prices are based on a 30-pill quantity in a 30-day period. Therefore, a 90-pill 30-day prescription at the discount pharmacies price would cost 3 times $4 or $12 total, as compared to this example of paying the $7 co-payment benefit under your Medicare Part D plan for the same 90-pill 30-day supply.
Other Part D plans noted that, while their Part D plans contain a higher retail co-payment, their mail order prescription fulfillment option is significantly less then discounted prices or may even have $0 co-payment for mail-order generics.
Bottom line: Be sure to contact your Part D plan for more information on your specific prescription drug coverage (the toll-free telephone number for your Member Services department is on the back of your Part D plan Member ID card).
Additions: We were also informed from one of our Newsletter readers ( a “thank you" to Don), that there are situations where purchasing medications outside of your Medicare Part D plan may still be counted toward your total prescription “spend" or True Out of Pocket expense (TrOOP). The Centers for Medicare and Medicaid Services (CMS) provides that when the Medicare beneficiary is 100% responsible for the cost of their medications (such as in the initial deductible phase or coverage gap / doughnut hole), they are able to purchase medications outside of their Part D plan and submit these receipts to their Part D plan so that the prescription costs can be counted toward their TrOOP or drug “spend".
Click here to review the complete Centers for Medicare and Medicaid Services (CMS) memorandum on the “Lower Cash Price Policy".
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On the other hand, if you do not use your Medicare Part D plan to purchase these lower-priced $4 generics, the total cost of your purchase will not be included in your True Out of Pocket (or TrOOP) cost for purposes of Doughnut Hole calculations. In other words, when you purchase medications outside of your Part D plan, they are not considered as part of your annual purchases when deciding when you go into - or out of the Doughnut Hole.
What is the best answer? There is no best answer and really depends on your situation. In many cases, such low-cost purchases have a minimal impact on TrOOP and Medicare beneficiaries may wish to simply save the few extra dollars by working outside of their Part D plan. However, other people may rather pay a little more and know that their prescriptions are recorded as part of their annual drug spending and Doughnut Hole calculations. If you wish to see the result of each possibility,
try our online PDP-Planner annual spending calculator (PDP-Planner.com) to get an idea of how purchasing outside of your Part D plan impacts your Doughnut Hole calculations.
And what if your Medicare Part D plan offers a $0 co-payment on generic prescription drugs? It would naturally be better to use your Part D plan and save even more over the discounted generic prices.
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5. Press Release – Voluntary National Recall of Digitek®
In late April, the U.S. Food and Drug Administration (FDA) posted a press release that the drug Digitek® is being recalled nationally. The press release notes that: “[t]he voluntary all lot recall is due to the possibility that tablets with double the appropriate thickness may have been commercially released. These tablets may contain twice the approved level of active ingredient than i[s] appropriate. Digitek® is used to treat heart failure and abnormal heart rhythms. The existence of double strength tablets poses a risk of digitalis toxicity in patients with renal failure. Digitalis toxicity can cause nausea, vomiting, dizziness, low blood pressure, cardiac instability and bradycardia. Death can also result from excessive Digitalis intake. Several reports of illnesses and injuries have been received."
What does this mean to you if you are using this medication? Ask your doctor or pharmacist about any medical concerns and report signs of Digitalis toxicity.
Do you need more information? The press release posted by the FDA also notes that: “[a]ny customer inquiries related to this action should be addressed to Stericycle customer service at 1-888-276-6166 with representatives available Monday through Friday, 8 am to 5 pm EST. Additional information about the voluntary recall can also be found at www.actavis.us.
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Last updated on: 07/18/2008
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