Prepare for Medicare Part D Launch in January


SAN DIEGO — Physicians will face many questions about new Medicare Part D benefit in coming months as patients decide whether to enroll and which plan to select in the voluntary prescription drug program, Elizabeth Carder-Thompson said at the annual meeting of the American Health Lawyers Association.

CMS has begun posting informational resources on its Web site, and additional materials will become available over the next few months. The best resource at this time is the “Outreach Toolkit,” available by download or on CD-ROM, said Ms. Carder-Thompson, a lawyer with Reed Smith LLP.

“The Outreach Toolkit doesn't answer all the questions we want answered, but it's a good start,” she said.

Enrollment for Part D begins on Nov. 15, 2005, and patients must enroll by May 15, 2006, or face a financial penalty when they do.

The new coverage goes into effect Jan. 1, 2006, and the interim discount drug card program ends at that time. That means Medicare beneficiaries will need to make fairly complicated choices in a short time.

There will be at least two part D prescription drug plans available in each geographic area, and plans may include several subplans.

A Kaiser Family Foundation survey, conducted March/April 2005, found that seniors are more likely to turn to their doctor (49%) or pharmacist (33%) for help in making these decisions, rather than to Medicare information sources (23%). About two-thirds (68%) of those surveyed said they did not have a good understanding of the new benefit.

In October 2005, Part D plans will start to send marketing materials. CMS will distribute its “Medicare and You,” handbook to all beneficiaries via mail, with a description of the new benefit. A “Plan Comparison Web Tool” and “Medicare Personal Plan Finder” will be posted at

“CMS says it will provide materials as they did for the drug discount card but this is far more complicated than the card,” Ms. Carder-Thompson said.

According to Robert J. Hill, also of Reed Smith LLP, the CMS marketing guidelines on part D include a great deal of material that will affect physicians. For example, enrollment cannot be taken at the point of care, such as a physician's office. If physicians offer their patients information on any part D plan then they must offer information on all available part D plans.

CMS has not released the final version of its marketing guidelines, and Mr. Hill expects these issues to be dealt with in more detail in the second part.

Once Part D becomes effective, doctors will face a different set of concerns, Ms. Carder-Thompson said.

When a plan doesn't cover a prescribed drug, physicians will need to provide supporting statements to get an exception, but many details are not clear at this time.

“The regulation is confusing,” Ms. Carder-Thompson said. “CMS says they don't want it to be hard to seek exceptions. However, it may well become an administrative burden. This is something that's going to evolve as we go along.”

Ms. Carder-Thompson advised doctors to “stay tuned” on the details of Part D, because they seem to be changing every day.

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