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

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