People With Medicare Should Act Now To Ensure Uninterrupted Drug Coverage In February, Consumer Group Advises

Main Category: Medicare / Medicaid / SCHIP
Article Date: 02 Feb 2010 - 3:00 PDT

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Every winter, millions of people with Medicare discover that their Medicare private drug plan will no longer cover a medicine they need. Consumers affected include: members of drug plans that dropped certain drugs from their list of covered drugs in 2010 or imposed new restrictions on a covered drug in the new year; consumers who switched plans but failed to check that all their medicines are covered under their new plan; and many of the one million low-income people with Medicare who were randomly reassigned to a new drug plan because their 2009 plan no longer qualified for a full premium subsidy.

To help minimize the negative impact of plans' restrictions on consumers, drug plans are required to have a transition policy to ensure that new members have uninterrupted access to drug therapy that started before they joined, and that existing plan members do not face interruptions to drug therapy when their plan imposes new coverage restrictions in the new year. Transition policies are effective for the first 90 days of the new plan year, and require that plans cover at least one 30-day supply of drugs even if they are not on the formulary, and also require that plans override their restrictions.

The transitional supply should give consumers time to get their doctor to switch their prescription to an alternative drug that is covered by their plan. If that is not clinically appropriate, the transitional supply gives consumers time to appeal the plan's denial, including an appeal to an independent review entity.

"Transition fills offer an important safeguard for consumers, but it is important that consumers act quickly to ensure they have an uninterrupted supply of the medicines they need," said Joe Baker, president of the Medicare Rights Center. "Your doctor can help by prescribing generic or lower-cost alternatives that are covered without restriction. If this is not an option, your doctor can help you appeal the plan's denial by certifying that the drugs covered by the plan are not as effective as the prescribed drug or are harmful to you."

Unfortunately, many consumers fall through the cracks. If people don't receive-or don't understand-the notice from their plan informing them that their prescription will no longer be covered after the transition fill runs out, they may run out of medicine in early February. Drug plans that fail to meet regulatory deadlines can also delay resolution of appeals until after the transitional supply is exhausted.

The Medicare Rights Center is available to help. The Medicare Rights Center offers free resources for people who want to learn more about Medicare private drug plans, transition fills and appeals. Visit Medicare Interactive, a free, web-based counseling tool, at http://www.medicareinteractive.org. A guide to the Medicare Part D appeals process is available for free here. To speak with a counselor, call the toll-free hotline at 1-800-333-4114. Counselors are available Monday through Friday, 9:00 am to 5:00 pm (Eastern Time).

The Medicare Rights Center is now on Twitter. Follow us at http://www.twitter.com/medicarerights.

Source
Medicare Rights Center

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