Pharmaceutical Research and Manufacturers of America
Renal Care Group, Inc.
The Renal Network, Inc.
Renal Physicians Association
Renal Support Network
Sigma-Tau Pharmaceuticals, Inc.
Social Security Administration
The Transplant Pharmacy Coalition
Washington Hospital Center
American Association of Kidney Patients, Inc.
American Kidney Fund
American Nephrology Nurses’ Association
The American Society of Nephrology
Astellas Pharma US, Inc.
Centers for Medicare & Medicaid Services
Central Florida Kidney Center, Inc.
DaVita Patient Citizens
The ESRD Network of New York
Fresenius Medical Care North America
Gambro Healthcare US
Kidney Care Partners
National Kidney Foundation, Inc.
Council of Nephrology Nurses and Technicians
Council of Nephrology Social Workers
Council on Renal Nutrition
People Like Us
National Minority Health Month Foundation National Renal Administrators Association Novartis Pharmaceuticals Corporation Pfizer Inc. Pharmaceutical Research and Manufacturers of America PKD Foundation Renal Care Group, Inc. The Renal Network, Inc. Renal Physicians Association Renal Support Network Roche Pharmaceuticals Sigma-Tau Pharmaceuticals, Inc. Social Security Administration Transplant News The Transplant Pharmacy Coalition UnitedHealth Group/Ovations Washington Hospital Center Wyeth Pharmaceuticals
Sandie Dean , Fresenius Medical Care of North America
Janet Miller, Centers for Medicare and Medicaid Services
Marge Watchorn, Centers for Medicare and Medicaid Services
Bob Whitlock, Missouri Kidney Program
John O’Brien, Pharmaceutical Research and Manufacturers of America
Phylis Ermann, American Kidney Fund
How Is the Standard Medicare Drug Plan Structured? *Plans vary by region and coverage. 5% of covered drug costs or $2 (generic) or $5 (brand name) after drug cost of $5,100 ($3,600 spent) Catastrophic (rest of calendar year) Up to $2,850 from $2,251-$5,100 (100%) Coverage Gap* Up to $500 from $251-$2,250 (25%) Coinsurance* Up to $250 out-of-pocket Deductible* Average $32.20/ mo Premium* What patient spends… Type Coverage
HealthWell helps with Part D co-pays, coinsurance and/or premiums for those taking oral drugs for anemia of CKD or ESRD and secondary hyperparathyroidism.
Patient Services, Inc. helps existing Medicare only clients with the Part B 20% co-pay for Aranesp ® or Procrit ® for those with anemia of CKD and helps those with transplants taking anti-proliferative drugs. Hopes to open enrollment in 2006.
Enhanced Medicare drug plans pay more or cover more than standard plans.
Medicaid may cover all or some Medicare excluded drugs.
SPAPs offer partial or full wrap around benefits.
Some states have state kidney programs. Four are qualified SPAPs.
The OIG advisory limits help pharmaceutical companies can give to Part D members without risking sanctions under the Social Security Act anti-kickback statute. Companies can contribute to charities with less risk.
Charities and foundations are working to develop programs to help pay all or part of eligible individuals’ premiums and cost shares.
Medicare is addressing issues with the duals and is proactively planning with advocacy groups for how to transition those who will be facilitated enrolled in June.