Medicare’s New Prescription Drug Benefit - What You and Your Patients Need to Know
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Electronic Prescription for Part D Drugs Announced

Medicare’s New Prescription Drug Benefit - What You and Your Patients Need to Know

You read about it in every healthcare magazine, it’s on the cover of the TV section on the Sunday newspaper and it seems every other ad on television and radio promotes Medicare’s new prescription drug benefit.  My approach to this article is to provide you with the basics to inform your patients and your own family members on the specifics of this program.

Introducing Medicare Part D
For the first time ever, the federal government is offering coverage for prescription drugs through prescription drug plans (PDPs) which are sold by insurers and subsidized and also regulated by Medicare.  Most states will have at least a dozen or more choices for coverage.  Beneficiaries should watch for the handbook entitled Medicare and You 2006 that is currently being mailed. It should detail the particular plans available to beneficiaries in their area.

Important Dates
Nov. 15, 2005 is the date enrollment begins for current Medicare beneficiaries and those who will be eligible by January 2006.  May 15, 2006 is the last day to sign-up for most beneficiaries without paying a penalty.  Jan. 1, 2006 is the date coverage begins.

To Help You Make a Decision
To assist beneficiaries in deciding on which of the many plans is best for them, recommend the following:

• Make a list of all the prescriptions taken.
• Identify exactly how much is paid for them individually.
• Identify a pharmacy of choice.
• Compare this information with each plan available to see which one best meets the beneficiary needs.

Out-of-Pocket Expense
Medicare projects that the average premium will be around $32 per month. Also under the standard plan, beneficiaries will pay a $250 deductible. 

Here’s the structure:

• Beneficiaries will pay 25 percent of the first $2,250 in prescription charges.
• Then beneficiaries will be responsible for all prescription costs until $3,600 is spent.
• Above that amount, Medicare pays 95 percent of your prescription costs for the rest of the year.

Confusion
Do you already have a prescription drug benefit? If so, consider the additional benefit the plan will/may offer.  And the number of options is overwhelming. If you don’t have prescription coverage now, sign up with Medicare.

Additional Information
The following are links to resources available from the Centers for Medicare and Medicaid Services (CMS), the federal government and advocacy organizations.

Physician providers

• General overview and starting point
• Training materials

Beneficiaries/patients

• Medicare.gov Web site
• Frequently asked questions (FAQ)
• Eldercare.gov: a Web site from the U.S. Administration on Aging
• AARP

Electronic Prescription for Part D Drugs Announced

HHS Secretary Mike Leavitt announced adoption by regulation of standards for the electronic prescription of Part D drugs to make the use of prescription drugs easier and safer for Medicare beneficiaries.  The final rule establishes a set of foundation standards for electronic prescribing (“e-prescribing”) of Part D drugs covered by Medicare. The industry is already experienced with these foundation standards, which will be available for immediate use when Medicare’s new prescription drug benefit begins Jan. 1, 2006.

E-prescribing enables a physician to transmit a prescription electronically to a patient's pharmacy of choice.  This is not only easier than paper prescriptions, but it can improve patient safety and reduce costs by decreasing prescription errors and automating the process of checking for drug interactions and allergies. E-prescribing will also help physicians, pharmacies, and patients obtain timely information on drugs based on the latest medical evidence, and obtain information from drug plans about a patient’s eligibility. 

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created a new voluntary prescription drug benefit under Medicare. Although e-prescribing will be optional for physicians and pharmacies, Medicare will require drug plans participating in the new prescription benefit to support electronic prescribing. Compliance with these standards will be required beginning Jan. 1, 2006, so they will be ready for immediate use when the Medicare drug benefit begins.

Along with the start of the Medicare drug benefit and implementation of the foundation standards, Medicare will begin a pilot project to test some additional e-prescribing standards addressing information on a plan's formulary and benefits, patient instructions, prior authorization messages, and clinical drug terminology. 

The e-prescribing final rule went on display at the Federal Register Nov. 2, and will be published on Nov. 7, 2005.