Medicare Part D: selected issues for pharmacists and beneficiaries in 2007

Upon signing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) on December 8, 2003, President Bush set in motion the greatest change in the Medicare program since its inception in 1965. MMA was implemented on January 1, 2006, and established the Medicare prescription drug benefit, also known as Medicare Part D. Community and managed care pharmacists were essential to the success in 2006 of this new benefit program with 33 million beneficiaries. Pharmacists will continue to be an essential and integral part of the continued success of the Medicare prescription drug benefit in 2007, in part by being informed about the policies and regulations.

To review policy statements released by the Centers for Medicare & Medicaid Services (CMS) for the Medicare prescription drug benefit in 2006 and to compile an abridged version of the highlights from the policy statements that may affect pharmacists and their interaction with Medicare beneficiaries.

We reviewed all policy statements that were released publicly via the CMS Web site (www.cms.gov) policy guidance section between January 1, 2006, and September 30, 2006. We read through approximately 100 guidance statements and summarized approximately 50 that were determined to be relevant to beneficiaries and pharmacists in various practice settings.

Policy statements that may impact beneficiaries of the Medicare prescription drug benefit in 2007 include the timeline for the annual coordinated election period, managed care open enrollment period, and distribution of annual notices of change to beneficiaries. Changes have also occurred in the standard benefit and cost sharing for low-income subsidy (LIS) or extra help that some beneficiaries are eligible to receive based on their current financial status. Discontinuation of coverage of erectile dysfunction drugs is a noteworthy coverage change. For all health care providers, the National Provider Identification (NPI) number will be used beginning May 23, 2007. Once the system using NPI numbers is required, no other provider identification number will be valid for billing Medicare and Medicaid.

Important policy updates to the Medicare prescription drug benefit in 2007 include the subject areas of: (1) beneficiary enrollment, (2) transition medication fills, (3) standard benefit, (4) cost sharing, particularly for those who qualify for LIS, (5) enhancement of the Medicare Prescription Drug Plan Finder, (6) beneficiary complaints, (7) discontinuation of coverage for erectile dysfunction drugs, (8) vaccine coverage by the Medicare prescription drug benefit, (9) syringes in long-term care, (10) donation of unused medications by beneficiaries, (11) implementation of the NPI, and (12) preventive services covered by the Medicare program.