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    • Medicare: How It’s Changing To Help More People Helping Patients Choose a Medicare Part D Plan Presented by: Kidney Medicare Drugs Awareness and Education Initiative www.kidneydrugcoverage.org
      • Welcome: Linda Keegan, Executive Director, KCP
      • Patient advocates
      • Dialysis professionals
      • Dialysis providers and suppliers
      • KCP’s goal:
      • Improve quality of care for those with kidney failure
      • KCP stimulated creation of Kidney Medicare Drugs Awareness and Education Initiative
    • KIDNEY MEDICARE DRUGS AWARENESS AND EDUCATION INITIATIVE A kidney community effort to help professionals and people with kidney disease understand Medicare prescription drug coverage
    • Participating Organizations
      • Abbott Laboratories
      • American Association of Kidney Patients, Inc.
      • American Kidney Fund
      • American Nephrology Nurses’ Association
      • The American Society of Nephrology
      • Amgen
      • Astellas Pharma US, Inc.
      • Centers for Medicare & Medicaid Services
      • Central Florida Kidney Center, Inc.
      • DaVita, Inc.
      • DaVita Patient Citizens
      • The ESRD Network of New York
      • Fresenius Medical Care North America
      • Gambro Healthcare US
      • Genzyme Corporation
      • Kidney Care Partners
      • National Kidney Foundation, Inc.
        • Council of Nephrology Nurses and Technicians
        • Council of Nephrology Social Workers
        • Council on Renal Nutrition
      • National Minority Health Month Foundation
      • National Renal Administrators Association
      • Novartis Pharmaceuticals Corporation
      • People Like Us, National Kidney Foundation
      • 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
    • Prior Teleconferences in Series
      • August 16 teleconference – upcoming changes and extra help for those with limited income and resources
      • September 20 teleconference – coverage coordination
      • Archived materials from teleconferences on www.kidneydrugcoverage.org
    • Medicare Part D Overview
      • November 15, 2005: First date to join a Medicare drug plan
      • Those with Medicare and Medicaid must join by December 31, 2005 or Medicare will choose their plan for January 1, 2006
      • May 15, 2006: Last date for people with Medicare now to join
      • People need to know their options to make the best decision for them
    • Our Experts…
      • Moderator:
      • Maureen McKinley , DaVita social worker, past chair of National Kidney Foundation Council of Nephrology Social Workers
      • Speakers
      • Tom Dudley , Division of Website Project Management, Centers for Medicare & Medicaid Services
      • Patricia Fuller , Division of Beneficiary Choices, Beneficiary Information Services, Centers for Medicare & Medicaid Services
      • Nancy Oliker, Director of Part D Education, UnitedHealth Group, a national prescription drug plan provider
      • Wendy St. Peter , Pharmacist, member of ESRD Network 8 technical advisory panel, Outpatient ESRD Medications
    • Who Needs Medicare Part D
      • Will help many with Medicare with some drugs, but if drug coverage is as good as Part D, may not need it
      • Plan sponsor’s creditable coverage notice
        • Notifies if “on average coverage is good as the standard Medicare prescription drug coverage”
    • About Medicare Part D
      • Coverage is not free
      • One in three Medicare beneficiaries may qualify for “extra help”
      • If have limited income and resources
        • Notice told who gets extra help automatically
        • If no notice, but think may qualify
          • Visit www.socialsecurity.gov
          • Call 1-800-772-1213 (TTY 1-800-325-0778)
      • No creditable coverage -- look at options
    • Key Factors in Choosing a Plan
      • Coverage
      • Cost
      • Convenience
    • What to Look For
      • A broad formulary
        • Before kidney failure, dialysis, transplant
      • Total annual cost for each plan
        • Premiums, deductibles, cost shares at all coverage levels
      • Accessibility
        • What pharmacy choices (retail, mail order)
        • Snowbirds consider plans in both states or that provide drug access outside plan area
    • Medicare Part D Covered Drugs
      • Must cover “all or substantially all”
      • Cancer medicines
      • HIV/AIDS drugs
      • Anti-depressants
      • Anti-psychotics
      • Anti-convulsants
      • Immunosuppressants
      • May not cover every brand name or all doses
      • Other categories, must cover at least 2 per class
    • Standard Part D Excluded Drugs
      • Anorexia, weight loss, weight gain
      • Fertility drugs
      • Cosmetic purposes, like hair growth
      • Cold and cough medicines
      • Non-prescription or over-the-counter
      • Barbiturates (e.g. Seconal ® , Nembutal ® )
      • Benzodiazepines (e.g. Restoril ® , Ativan ® )
      • Vitamins and minerals
        • Except prenatal vitamins, fluoride preparations, Vitamin D
      • “ Enhanced” plans may cover excluded drugs
    • How to Find Out Covered Drugs
      • Contact every plan provider in area
        • Time consuming with number of plans
      • Use Medicare Prescription Drug Plan Finder tool
        • Provides customized cost sharing information (PDPs, MA-PDs, Special Needs Plans)
        • Considers patients’ eligibility for “extra help”
    • Using Drug Plan Finder Tool
      • Authentication Route
        • Enter personal information
        • Confirms identity with Medicare Beneficiary Database
        • Provides customized information with personal data
      • General Search Route
        • Use if don’t have 5 key data elements
        • Use if don’t choose to enter personal information
        • Provides general information based on answers given
      • Enroll Directly Route
        • Use if have done research
        • Enroll with plans starting November 15
    • What You Learn |From Drug Plan Finder Tool
      • Includes what plans choose to include
      • Formulary information
      • Network pharmacy information
      • Beneficiary cost sharing information
        • Deductibles, premiums, co-pays, coinsurance
      • Whether patient is likely to reach coverage gap (catastrophic coverage level)
    • Online Enrollment Center
      • Available November 15, 2005
      • Accepts enrollments into plans that opt to participate in Online Enrollment Center
        • PDPs
        • MA-PDs
    • Preparing to Use the Drug Plan Finder Tool
      • List drugs, dosages, number per month
      • Look up what drugs cost now
      • Search for up to 25 drugs at a time
      • Searching for pharmacies
        • If do now, may narrow options
        • Can look later once tool compares plans
    • Comparing Plans Online
      • Can compare up to 3 plans side-by-side
        • Premium, deductible, cost share
        • Pharmacy network
        • Whether prior authorization is needed
      • Spanish version available November 15
      • Americans with Disabilities Act compliant
        • Larger text options
        • Can be used with screen readers
      • People can use libraries or ask others for help
    • Options other than Internet?
      • Medicare & You 2006 booklet
        • Contacts for PDPs and MA-PD plans
        • Spanish version available January 2006
      • 1-800-MEDICARE or 1-877-486-2048 (TTY)
        • Customer service representatives use Medicare Drug Plan Finder tool to compare plans if shares personal information and drugs
        • Can mail out “print-on-demand” booklet
        • Can mail other Medicare booklets
      • See CSR scripts at www.cms.hhs.gov/partnerships
      • November 15, 2005: First date CSRs can enroll
    • Determining Cost of Plan
      • Use authentication option to find cost share based on subsidy level
        • Drug Plan Finder online www.medicare.gov
        • 1-800-MEDICARE
          • Enrolled in a drug plan already?
          • Employer claiming subsidy?
    • Standard Medicare Drug Plan *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 year) Up to $2,850 from $2,251-$5,100 Coverage Gap* Up to $500 from $251-$2,250 Coinsurance* Up to $250 out-of-pocket Deductible* ≤ $37/mo ( average $32.20/ mo) Premium* What patient spends… Type Coverage
    • For Those Without Extra Help
      • For drugs costing $5,100 in 2006, they pay $3,600 with possible help from:
        • Family or friends
        • State Pharmacy Assistance Program (SPAP)
        • Charities
      • Over $5,100 in 2006, they pay:
        • 5% of covered drug costs; or
        • $2 (generic) or $5 (brand name)
    • Low Income Subsidy
      • Sliding scale premium to national average premium
      • $50 deductible
      • 15% of covered drug costs to $5,100 (or $3,600 spending); or
      • $2 (generic); $5 (brand name)
      Income 135 to <150% FPL $14,355 (single); $19,245 (couple) AND Resources less than $11,500 (single); $23,000(couple)
      • No premium
      • No deductible
      • $1 (generic); $3 (brand name)
      • Nothing after drug costs are $5,100
      Income less than 135% FPL $12,920 (single); $17,320 (couple) AND Resources less than $7,500 (single); $12,000 (couple) What they pay… Income and resources
    • Enrolling in a Plan
      • Only Medicare beneficiaries can enroll or legal representatives can enroll them
        • Online at plan’s website or www.medicare.gov
        • Phone to plan or 1-800-MEDICARE
        • Mail application to plan
      • Plan receives application and mails enrollment packet and ID card
    • Premium Payment Options
      • Automatic deduction from Social Security or Railroad Retirement check
      • Pay by check
      • Electronic transfer from bank account
      • Billed to a credit card
    • Contact the Plan to Learn
      • Network pharmacies in the network
      • Costs of the plan
      • Covered drugs (formulary)
        • Medical condition
        • Alphabetically
    • Plans’ Formularies
      • CMS approves formulary changes
      • Plans must update CMS
        • Monthly on formulary changes
        • Weekly on price changes
      • Plans must give 60-days notice of formulary change
      • Plan does not have to give advance notice if FDA removes a drug as unsafe
      • Most changes occur when for new drugs added
      • Call customer service for questions
    • Options When Formulary Changes
      • Switch to another drug in category
        • Ask plan what other drugs are covered
        • Talk with doctor options
      • File an exception request if drug is medically necessary
      • Change plans – everyone can change at least once a year November 15-December 31
      • NOTE: Topic of November 15 teleconference -- Coverage determination and exception requests
    • Generics or Brand Name Drugs?
      • Plans will cover generics and brand name drugs
      • Plans may encourage generic use
      • Plans may have drugs on tiers
        • Tier 1: Generic drugs
        • Tier 2: Preferred brand name drugs
        • Tier 3: Expensive, non-preferred brand name drugs
    • About Network Pharmacies
      • Plan networks
        • Preferred pharmacies
        • Non-preferred pharmacies
      • Costs will be higher at non-preferred ones
      • Show ID to avoid paying full price
    • Finding Network Pharmacies Without the Internet
      • To search plan directories of preferred and non-preferred pharmacies
        • Call plan’s customer service department
        • Call 1-800-MEDICARE or 1-877-486-2048 (TTY)
    • Especially for Rural Patients
      • Find pharmacy options in Medicare Prescription Drug Plan Finder Tool
        • Which plans have mail order options
        • Cost for prescriptions through mail order
    • Pharmacy Changes
      • Plans can add any time
      • Plans can remove any time
      • Plans more likely to remove if pharmacy closes
      • To get most current list
        • Visit plan’s website
        • Call plan’s customer service department
    • Drug Limits at Pharmacies
      • Limit may be 30-day supply (retail)
      • Limit may be 90-day supply (mail order)
        • 90-day supply from mail order pharmacy may cost less than 3 times co-pay
      • Retail pharmacies may offer more than 30-day supply for price similar to mail order
      • May order all or some drugs by mail order pharmacy to save money and for convenience
      • Plans must tell members all ways to order drugs
    • Case Study Person on Dialysis
      • Nephrocaps ® 1 qd
      • Renagel® 800mg 2 tabs w/meals and snacks
      • Sensipar® 30mg 1 qd
      • Cardiazem CD® 1 qd (G)
      • Prinivil® 10 mg 1 qd (G)
      • Zocor® 80 mg 1 qd
      • Glucotrol® 10 mg 1bid (G)
      • Aspirin EC 325mg 1qd (G)
      • Darvocet® 1 q8 hour prn (G)
      • Ativan ® 0.5mg 1 q8 hour (G)
      • Ambien® 5mg 1 q HS
      • Epogen® 3,000 IU every dialysis
      • Venofer® 100mg IV qowk
      • Zemplar® 5mcg IV q dialysis
      G = Available in generic
    • Case Study: Transplant Recipient
      • Prograf ® 1mg 2 bid
      • Cellcept ® 500mg 2 bid
      • Deltasone ® 5mg 1qd (G)
      • Diflucan ® 100mg 1qd (G)
      • Bactrim ® 1 qd (G)
      • Protonix ® 40mg 1qd
      • Valcyte ® 450mg 2 bid
      • Zantac ® 150mg 1 qd (G)
      • Lantus ® 22 IU @HS
      • Humalog ® 5 IU @meals
      • Prinivil ® 10mg qd (G)
      • Zocor ® 80 mg @HS
      G = Available in generic
    • Information about Drug Status from Case Studies
      • Some drugs are excluded
        • Vitamins, aspirin, Ativan ®
      • Drugs covered under Part B
        • Epogen®, Zemplar®, Venofer®, Prograf®, Cellcept®, Deltasone®
      • Excluded drugs and Part B drugs do not count toward $3,600 in true out-of-pocket costs
      • Part D may cover all other drugs
      • Generic drugs may cost less
      • Immunosuppressants could be covered under Part D if not eligible for coverage under Part B
      • When Medicare ends, Part D ends too
    • Diabetes and Part B or Part D
      • Medicare Part B covered
        • Diabetes meters
        • Test strips
        • Lancets
      • Medicare Part D may cover
        • Syringes and needles
        • Gauze and alcohol swabs
        • Insulin delivery devices (pens & supplies)
    • Tips to Save the Most on Medicare Drug Plans
      • Search for most expensive drugs first
      • Search for these drugs on lowest tiers
      • Try to avoid plans requiring prior authorization
      • Search for less expensive drugs; consider generics
      • Look for convenient pharmacy network
    • Remember Resources for Choosing a Plan
      • Medicare Prescription Drug Finder Plan
        • www.medicare.gov
      • Medicare customer service representatives
        • 1-800-MEDICARE
      • Kidney-specific information
        • www.kidneydrugcoverage.org
    • Thank You
      • Moderator:
      • Maureen McKinley , DaVita social worker, past chair of National Kidney Foundation Council of Nephrology Social Workers
      • Speakers
      • Tom Dudley , Division of Website Project Management, Centers for Medicare & Medicaid Services
      • Patricia Fuller , Division of Beneficiary Choices, Beneficiary Information Services, Centers for Medicare & Medicaid Services
      • Nancy Oliker, Director of Part D Education, UnitedHealth Group, a national prescription drug plan provider
      • Wendy St. Peter , Pharmacist, member of ESRD Network 8 technical advisory panel, Outpatient ESRD Medications
    • Key Messages
      • Medicare drug plan will help some; others may not need it
      • Most information you read is for the “average” person with Medicare
      • Kidney Medicare Drugs Awareness and Education Initiative provides kidney-specific information
      • “ Kidney friendly” plans provide the most help
      • Ask patients to bring notices to review, advise about creditable coverage, keep for appeals
    • The right information at the right time…
    • Thank You For Participating…
      • Listen at noon ET on November 15, 2005 for information on impact of tiers, utilization management, coverage determinations exceptions, and medication management therapy
      • Visit www.kidneydrugcoverage.org for today’s materials
      • Complete evaluation
      • Print your certificate of attendance
      • Ask your licensing board if certificate can be used for continuing education credit
      • Submit questions about Medicare Part D to [email_address]