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NEWSLETTER
OCTOBER 2005
MEDICARE
INFORMATION:
At last count CMS has approved about 389 different PDP's or Advantage
programs for the new Medicare Modernization Act (MMA) starting
January 1st, 2006. This alone gives you enough reason to be part
of a Managed Care Program.
AmerisourceBergen
Customers use PPN as their managed care program.
Cardinal customers use the Leadernet program.
Also available and endorsed by Keystone are the EPN & United
Networks.
These are all excellent programs and each has been endorsed by
Keystone.
For information
on joining, call our office or talk to your wholesaler representative.
Each of the plans have been very careful in approving & not
approving certain plans and as a member of these Managed Care
plans, you do not have to read these complicated contracts and
they automatically enroll you in the approved plans. You, of
course, still have the ability to sign on to any plan they do
not approve.
PACE program
in Pennsylvania:
We have been unofficially told the following. Pa. PACE is going
to provide an excellent wrap around benefit; PACE will cover
all costs not picked up by the PDP (First Health Plan) except
for the $6 co-payment. PACE is only going to auto assign its
members who qualify for the Low Income Subsidy (LIS) into a PDP.
For those who do not qualify for LIS, there is NO INCENTIVE for
them to join a Medicare PDP PACE & PACENET are better
plans than those offered under Medicare Part D. Bottom Line
PACE members need to do nothing.
If a recipient
is now receiving Medicaid or SSI they will also be auto
assigned if they do nothing.
Answers
to the most commonly asked questions:
1. If Medicaid is presently paying for their prescription: On
January 1, 2006, your prescription benefits will be under Medicare
Part D. They must choose a Part D PDP, or Medicare will choose
one for them. Those recipients in a Medicaid HMO will be contacted
by their plan with their offers. The recipient can then stay
with their present HMO or switch to another if they feel it offers
a better plan for them personally.
2. If a patient is receiving Supplemental Security Income (SSI):
They will be covered by Medicare Part D. They have until May
15, 2006 to choose a plan or one will be assigned.
3. Medigap Members: They can choose another Medigap plan that
does not offer drugs and sign up for drugs with a Part D Plan.
They can drop their Medigaps plan Rx coverage and sign up for
Part D. They can keep their Medigap plan with Rx coverage, but
as Medigap drug coverage will probably be phased out they may
be subject to a late-enrollment penalty if they go back to Part
D at a later time.
If they are part of a Medigap Plan that does not offer drugs,
then they can sign up for Medicare Part D if they feel it is
beneficial.
4. If they are getting help paying for drugs from a former employee
or union: The former employee or union will be letting them know
how Medicare Part D will work with their coverage. To keep these
plans active, the Federal Government is offering to pay 28% of
the employer or union costs so it is hoped that these people
will have to do nothing.
5. If you are receiving prescriptions from the VA: Do nothing,
your VA benefits will remain the same.
6. Low Income Subsidies (LIS) General Guidelines:
Single: Income less than $14,355 and assets less than $10,000
Couple: Income less than $19,245 and assets less than $20,000
Assets do not include the value of your home, car, certain earned
income or certain property related to burial expenses. If not
sure, it pays to apply for the Low Income Subsidy. This is managed
by the Social Security Administration. Apply at their offices,
call 800-772-1213 or go to www.socialsecurity.gov. A copy of
the LIS application is attached feel free to copy and give
to your patients.
KEYSTONE
NEWS:
Contract
proposals for 2006 are in hand and will be voted on by the Keystone
Board in the end of November. Many of the contracts have been
embellished by the Vendors because of strong participation and
competition in certain categories is very exciting.
LEGISLATION:
You have
been requested by all Pennsylvania Pharmacy Organizations in
the State to get involved and contact your legislators about
the "One Pennsylvania Act" which are in both the Pennsylvania
House and Senate. THIS IS VERY IMPORTANT!!!! GET INVOLVED!!!!!
Nationally,
there are those in Washington that are pushing to have AWP replaced
with AMP in all federally funded Medicaid Plans which would be
devastating to Pharmacy. In many, many cases AMP would be lower
than you can purchase a drug because it averages the prices charged
to Retail with those prices charged to Mail Order, LTC, Hospitals
as well as SB340 pricing. We have to educate our Federal Legislators
GET INVOLVED!!!!
Please
remember:
Keystone & the PARD share the same offices. If you have a
question, please call. We have worked for Independent Pharmacy
in the past & will continue to do everything possible in
the future. Ideas and suggestions by our membership are appreciated.
COMPLIANCE
IS THE KEY
IN KEYSTONE!!!!!!!
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