MEDICARE RX BYTES

February Medicare Checklist

Medicare Part D has provided significant challenges to community pharmacists across the nation. Below is a checklist of things to keep in mind to help make February smoother than January. Stay tuned to the Medicare Resource Center for continual updates to this list and more Medicare information.

Overall Checklist

• Recommend that new Medicare enrollees only sign up into plans before the 15th of the month.  Any enrollment later in the month may result in eligibility problems in March.
  
• In most cases, do not use transitional prior authorization codes after the first Rx fill. Most transitional policies will terminate after the first fill. 
  
• Formulary management: work with your patients to move from non-formulary drugs as soon as possible.  Remember, plans are required to notify pharmacists 60 days prior to any formulary switches.
  
• Educate your patients about the appeals process. All Part D plans are required to have formal appeals processes for non-formulary medications that are deemed medically necessary. Be prepared to educate your patients/caregivers so they can call their plan and start this process early in the month.
  
• To help with cash flow problems, contact your wholesaler to request an extension of terms.

Special Concerns for Dual Eligibles

• Recommend to any dual eligibles interested in switching plans to do so by the 15th of the month. Any enrollment later in the month may result in eligibility problems in March.
  
• Contact your state Medicaid office to ensure that you receive payment for any dual eligible claim sent to Medicaid rather than Medicare Part D in January and to determine how to bill for Medicare Part D excluded drugs (e.g., benzodiazepines, barbiturates, OTCs, etc.)