Understanding Medicare Part D Drug Plans

NY State Medicare/Medicaid Part D Plans (click here to link to the website and the formularies of all 11 plans in NY State) or for a more comprehensive and updated listing use www.fingertipformulary.com

Part D Standardized Appeal formThe newly standardized form can be used to request either approval for a drug not in a plan’s formulary or an exception to a formulary tier, and for providing data to meet prior authorization requirements. Just complete and fax to the plan.

Physician Part D Resource Fact sheet (pdf)

Formulary Finder (the CMS site’s national formulary finder site)

FOR ONE-TO-ONE PATIENT COUNSELING ABOUT MEDICARE PART D

Counselors are available at these 2 nearby resource centers to assist your Medicare patients with understanding the new Medicare Part D Prescription Drug Coverage Program.

Isabella Senior Resource Center (2 blocks from AIM)

4026 Broadway (169^th St, next to Radio Shack)

Please ask your patient to call 212 543-4645 to arrange an appt. They may also be able to see the patient the same day, depending on the number of counselors present. They are closed Sundays and Mondays, and are open Tuesdays 10am-6pm and all other days 8am-4pm.

ARC Fort Washington Senior Center

4111 Broadway (corner of 174^th St.)

212-781-5700

FOR PATIENTS WITH INTERNET ACCESS

http://www.benefitscheckup.org – A nice website with a decision support questionnaire that allows seniors to learn the following:

• How their current insurance or other prescription drug coverage affects their options and rights under the new Medicare Prescription Drug Coverage.
• Whether they qualify for extra help with your costs under the new Medicare Prescription Drug Coverage.
• If they are likely eligible for additional government benefits that can save them money on their medications.
• If it makes sense for them to start comparing the plans that are available in their area.

May be helpful for the physicians also, if he/she like to go through the questionnaire to understand how the plan impacts our patients (using the average AIM patient demographics).

www.medicare.gov – Provides a variety of interactive tools and assistance, and a help line (1-800-MEDICARE) is staffed around the clock.

www.eldercare.gov – Provide info to patients about nearby counseling centers

PATIENT HANDOUTS AND INFORMATION

www.medicare.gov – Has info in Spanish and English, some helpful ones are

• “Learn How Plans Work” click on top for Spanish version
• “Prescription Drug Plan-Basic Information”
• “Prescription Drug Plan-Things to Consider”

OTHER USEFUL RESOURCES

• Table from the NEJM article Bach and McClellan 353 (26): 2733, 29 December 2005 [Table 1]
• Also for those physicians interested in learning more about the plan, there is a training course with pre and post test downloadable from this site www.cms.hhs.gov/medlearn/drugcoverage.asp (comes with CME)