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MEDICARE Part D is coming . . . .

While the knitty gritty details are still not in place, there is information you should be know. Under Medicare, group enrollments will no longer be solely controlled by the giant PBM's. When enrollment process starts this fall, you will have the opportunity to educate your customers about the plans YOU have accepted. Over the next couple of months you will be receiving network service contracts from one or more potential Prescription Drug Plans (PDPs). These will not be one page proposals, but rather 10-15 page proposals filled with "may", "expect", "we believe", "we have the chance to", because these PDPs are just trying to set up a network of pharmacies. In truth, your pharmacy education does not prepare you to realistically read these proposals. As previously transmitted to you, Keystone recommends that each of its stores become part of a Keystone Endorsed Managed Care Organization (MCO) that has the expertise in reading & understanding these proposals. In the past, many of you have signed on to network contracts that were financially unfair because rejecting those contracts meant that their customers could no longer receive benefits at your store. We believe many patients will choose from the set of plans accepted by their current pharmacists. In Pennsylvania, the PACE Program and the Medicaid Programs will be very involved & our parent company, the PARD is already involved in these negotiations.

Most importantly, you must read over these proposals and say NO to plans that are considered unfair in reimbursement and NOT just sign every plan that comes across your desk. You must learn from past mistakes.

Should you receive unfavorable contract offers from one or more potential PDPs, Keystone wants you to know that you have a choice. You have a choice to reject unfair agreements. The present framework of the Medicare enrollment process empowers you to keep your customer base without accepting unfair contracts.

Evaluate your offers. Educate your customers. Work with plans that work with you.

TIME TABLE: On October 1st, PDPs will begin to market their plans. Medicare & the PDPs will be sending out extensive information that will confuse your patients just as the temporary Medicare-approved Drug Discount Cards did these past two years. What will vary from plan to plan will be the actual drug coverage, premiums, co-insurance and co-payments. Beneficiaries are advised to know their income and assets and to have a list of their drugs and doses ready when they are prepared to enroll. This is where YOUR input is most important & where you can point them in the right direction.

Enrollment starts November 15 and is completely voluntary. HMOs and PACE will probably automatically enroll their patients in THEIR approved PDP.

For more information on the 2006 Medicare benefit, the National Community Pharmacists Association is offering a free online CE on the 2006 Medicare program. To access the CE, visitwww.pharmacistelink.com/medicare. Most of this information was obtained through NCPA literature. NCPA's Community Care Rx PDP should be your first choice of programs to accept.

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