Highlights From January 26 Region IX Stakeholder Call
Following is a brief overview of the stakeholder conference call lead by Jeff Flick today:
States On Track To Federal Part D Reimbursement – The Federal Government is moving to quickly provide a process to reimburse states who have stepped up to be the payer of last resort for duel Medicare beneficiaries who have had problems accessing the medications they need during the transition to Part D coverage. (Newsday.com Story)
Clarification On The First Fill Rule – According to CMS the first fill rule is applied to all new members regardless of when they enroll in the system. The rule is NOT applied to January 2006 only.
Managing Beneficiary Expectations – The letter of the MMA law states that a beneficiary can enroll in to a new plan on the 31st of the month and receive the plan benefits on the first day of the next month, the next day in this case. New language is being drafted by CMS to help plans manage the expectations of beneficiaries who submit elections near the end of the month.
Pharmacy Exceptions Communication Challenge – Beneficiaries are not generally educated on their specific plan’s pharmaceutical exception and prior authorization process, resulting in confused, frustrated and at risk beneficiaries with out an understanding as to why they can not access their medications and how to resolve their problems. Plans are encouraged to reach out to their beneficiaries directly and through advocacy groups to help them sort through the challenge and resolve the conflict.
