October 17, 2005

Dear HRSA Grantee:

On September 23 the Centers for Medicare and Medicaid Services (CMS) announced formal approval of specific Medicare prescription drug plans and Medicare Advantage plans that will offer new prescription drug coverage starting January 1, 2006.

The prescription drug plans, and the Medicare Advantage plans that offer drug coverage and additional benefits, began marketing their plans on October 1. More details on those plans will come in the next few weeks. In brief:

• Prescription drug plans have been approved in every State -- with no area needing the "fallback" plan that would have been required in areas without at least two competing organizations.
• Between 11 and 20 organizations will offer prescription drug plans in each region.
• Ten organizations will offer drug coverage nationwide.
• Every State but Alaska has at least one prescription drug plan with a premium of less than $20 a month.

A map of the prescription drug plans and Medicare Advantage plans operating in each State can be found on the CMS Web site. A list of the 10 national plans and the local plans in Excel format also are on the CMS Web site.

To help seniors make decisions, CMS will target information to them that describes the new Medicare prescription drug coverage:

• Every Medicare beneficiary will have received in the mail a copy of the “Medicare & You 2006 Handbook” by October 15, and the handbook was made available on CMS’ Web site on October 1.
• The September 25 edition of PARADE Magazine provided an overview of the new coverage in a special insert.

Three tools will be made available on www.medicare.gov so that beneficiaries, or someone helping them, can enter information into on the web in order to identify the prescription coverage that is right for them. These tools are:

• Medicare Personal Plan Finder (now available);
• Medicare Prescription Drug Cost Estimater (available October 13); and
• Medicare Prescription Drug Finder Tool (available October 13).

Seniors not able to use the Web who want to take advantage of these tools are encouraged to call 1-800-MEDICARE or seek free counseling from their State Health Insurance Assistance Program. Those who call 1-800-MEDICARE can ask that the information generated from the web-based tools be printed out and mailed to them.

Additionally:

• In late October, CMS will mail auto-enrollment information to dual-eligible Medicare beneficiaries to inform them of the new Medicare prescription drug plan they will be enrolled in unless they select another plan.
• Beneficiary enrollment into plans starts on November 15, as scheduled.
• Auto-enrollment for low-income beneficiaries is on schedule. The list of plans on CMS’ Web site includes those plans that are eligible to receive beneficiaries to be auto-enrolled.

In order to accept patients’ Medicare Prescription Drug Cards, health centers must have a contract with those plans in which patients are enrolled. Please contact your regional CMS pharmacist advisor if you have questions.

We understand that some providers who participate in HRSA’s 340B Drug Pricing Program are unclear about how that program will interface with the Medicare Part D Program. Providers that participate in the 340B Program will continue to order and acquire drugs as they currently do. Drugs purchased through the 340B Program may continue to be dispensed to all patients of the provider regardless whether the patient is enrolled in a Part D plan. To receive reimbursement from Part D plans, it is up to the provider to negotiate contracts with the Part D Plans that their patients are enrolled in. Otherwise, the provider will not be able to obtain reimbursement for drugs dispensed to patients enrolled in these plans.

CMS’ Web site offers detailed information for providers. HRSA also provides information specific to safety-net providers, which offers a frequently asked questions (FAQ) section and includes a feature for sending in questions.

As we work together to make this new prescription program a success, I urge you to become well-informed about this program, ask questions and seek to help your patients make the best choice possible.

Sincerely,

Elizabeth M. Duke
Administrator