Medicare Part D Prescription Drug Plan (Part D)
What Nephrologists and Transplant Physicians Need to Know
Joining and Switching Part D Plans
The deadline to join Part D for those with Medicare on January 31, 2006 is May 15,2006. Others can join a Medicare Part D plan when they are first eligible to sign up for Medicare.
- USRDS data shows that many with kidney disease will benefit from joining a Medicare Part D plan.
- Most people with Medicare Part A or B who do not have drug coverage as good as Medicare Part D (“creditable coverage”) should join a Part D plan. Employers or plans must provide creditable coverage notices.
- Those who will lose their employer health plan by joining a Medicare Part D plan should not join. Employers can advise them of this.
- Patients without creditable coverage who choose not to join by the deadline will pay 1% more each month they delay or 5% higher premiums in 2007. The penalty has no cap.
- After May 15, most people can only join or change plans from November 15 to December 31 each year. Those with Medicare and Medicaid or state help to pay Medicare premiums can change plans any month.
Encourage your patients to join if they are eligible, do not have creditable coverage, and will not risk health coverage by joining.
Examples of Part D Problems
- Some patients with Medicare and Medicaid (dual eligibles) were missed in auto-enrollment and had no plan.
- Others were auto-enrolled or enrolled in Part D plans and some medicationsare not on plans’ formularies or limits apply.
- There were eligibility identification problems.
- Pharmacists did not know whether to bill Part B or Part D for certain medications.
Despite problems, many people with kidney disease will benefit from Medicare Part D.
How You Can Help
- Help patients make a list of medications they should take now and may need if their health or treatment changes.
- Help patients request coverage determination to get the drugs they need.
- Requests can be made for exception to prior authorization, step therapy, quantity limits, and tiers.
- Physicians can help with the first 2 of 5 stepsof appeals. Physicians as authorized representatives can help with others.
- Do not rely on social workers who have no medical training or knowledge of medications to give medical justification or suggest other medications.
- Note on prescriptions Part B or Part Dfor medications that could be covered under Part B or Part D, e.g. immunosuppressant or erythropoietic agentsso the pharmacist knows to bill Part B or Part D (
You can make the difference in whether your patients get the medications they need.
Helpful Resources
- General Part D resources for MDs
- Kidney-specific resources
- Presentation by Wendy St. Peter, Pharm.D. at NKF Clinical Meeting 2006
- Kidney Medicare Drugs Awareness and Education Initiative
- For problems or concerns with Part D:
- CMS regional offices (see St. Peter presentation)
Your patients value what you tell them about Part D. There are many resources to help you help your patients.