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| Medicare Part
D |
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SELECTING A MEDICARE PRESCRIPTION DRUG PLAN
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| How do I compare
the different Drug Plans? You will need to consider each Drug
Plan’s coverage, the cost to you, and convenience. Medicare Drug Plans will
vary because each one will have its own formulary (discussed below), monthly
premium, and network of pharmacies. Find out if your current pharmacy is
included in the Drug Plan’s pharmacy network and how much the monthly
premium will be if you join. The monthly premium will vary depending on the
whether the Drug Plan offers supplemental benefits above Medicare’s minimum
requirements. Each Drug Plan’s formulary must meet Medicare’s requirements.
However, you should contact the Drug Plan to determine if your drugs are
included in the Drug Plan’s formulary. |
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| What is a
“Formulary”? The formulary is a list of drugs covered by the Drug
Plan. Drug Plans must cover all of the types of drugs required by Medicare,
but within each drug-type, Drug Plans can limit which specific drugs they
will cover. They can also charge different cost-sharing amounts for
different drugs within a drug-type. However, there are six categories of
drugs – including antidepressants and HIV/AIDS categories – in which
Medicare requires each Drug Plan to cover all of the prescription
drugs in those drug categories, regardless of the Drug Plan’s formulary.
You can get a list of the drugs covered by a Drug Plan by calling the Drug
Plan, checking the Drug Plan’s website, or going to
www.medicare.gov. |
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| What if my drugs
are not included in my Drug Plan’s formulary? If the Drug Plan you
join does not cover your exact prescriptions, the Drug Plan is required to
have a transition period where your current drugs may be covered for a
certain period of time while you and your doctor work to find an alternative
prescription drug to take that is covered by the Drug Plan. However, if you
are currently stabilized on certain specific prescription drugs, including
drugs for depression and HIV/AIDS, you do not have to switch to a different
prescription drug. If one or more of your drugs are not included in the
formulary, and you feel it should be covered, you have the right to request
an exception (or a “coverage determination”) from your Drug Plan. You or
your doctor can call or write your Drug Plan to request coverage of a
particular prescription(s). Once your Drug Plan receives the request, it has
72 hours (for a standard request) or 24 hours (for an expedited request) to
notify you about its decision. Your request will be expedited if your doctor
tells your Drug Plan that your life or your health will be seriously
jeopardized if you have to wait for a standard decision. You can appeal the
decision if your Drug Plan decides against you. |
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| Clotting Factor
isn’t covered under Medicare Part D, so how will it be covered in the
future? In general, outpatient prescription drugs that have been
approved by the Food & Drug Administration (“FDA”) are included in the Part
D Program. However, if a drug is otherwise available and/or payable under a
different Medicare Program (e.g., Medicare Part A or Medicare Part B), it is
excluded from coverage under Medicare Part D. Because clotting
factor is covered under the Medicare Part B Program, it will not be covered
by the Medicare Part D Program. You will continue to receive
coverage of your clotting factor through your Medicare Part B coverage.
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| What if the
prescription I take is not covered by my Drug Plan? Will Medicaid still pay
for it? If Medicare covers a prescription drug, after January 1,
2006, Medicaid will not pay for it. Some state Medicaid programs may
choose to cover some or all of the few remaining prescriptions that are not
covered by the Medicare Part D Program. However, you should also note that
the Drug Plans do not have to cover every drug, they just have to cover
every drug-type. Before joining a Drug Plan available in your area, review
what drugs each Drug Plan covers and try to join a Drug Plan that covers all
or the majority of the same prescriptions that you take now. |
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If you have
further questions or need assistance, contact your Hemophilia Treatment
Center Social Worker.
Click Here for the Medicare Part D Flow Chart |
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