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GeneralInitiative.ppt

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  • 1. A KIDNEY COMMUNITY INITIATIVE TO HELP PROFESSIONALS AND PEOPLE WITH KIDNEY DISEASE UNDERSTAND MEDICARE PRESCRIPTION DRUG COVERAGE
  • 2. OUR MISSION
    • The Kidney Medicare Drugs Awareness and Education Initiative is a service of the kidney community, designed to provide timely, consistent, reliable, and up-to-date information about Medicare and Medicare Prescription Drug Coverage (Part D).
  • 3.
    • Ensure accuracy and comprehensiveness
    • Enhance credibility
    • Avoid duplication
    • Minimize confusion
    OBJECTIVES
  • 4. OUR CHALLENGE
    • Medicare Part D is complex to understand, much less explain.
    • Most materials and services are not geared to people with kidney disease and professionals that treat them.
    • Many people think Medicare Part D is only for those with low income.
    • Many don’t want to ask the government for help.
  • 5. More Challenges
    • Awareness is limited, understanding is poor, and intent to enroll is low.
    • Most must take action by May 15, 2006 to get the most savings and avoid higher premiums.
    • Acceptance and use of Medicare Part D to its fullest will require:
      • Ongoing consistent education;
      • Communication between patients and healthcare providers.
  • 6. OUR TARGET AUDIENCES
    • Patients
    • Physicians and office staff
    • Kidney care team
    • Dialysis providers
    • Transplant facilities
    • Kidney organizations
    • Government (CMS, SSA)
    • Federal contractors (Networks, SHIPs)
    • Specialty pharmacies
    • Media
  • 7. BACKGROUND
    • Novartis community meeting in Spring 2005 showed how confused kidney community was about Part D
    • Kidney Care Partners suggested NKF take lead to form community-wide initiative
    • Reviewed and collected materials from:
      • Federal and state agencies
      • Other kidney organizations
      • Other health organizations
      • Health and patient advocacy groups
    • Held planning meetings with community representatives
    • Held workgroup meetings
    • Established communications with agency key personnel
    • Developed communications plan
    • Began developing kidney-specific resources
  • 8. OUR KEY MESSAGES
    • Medicare is about to undergo significant, historic change as it implements prescription drug coverage (Part D).
    • Medicare Part D offers most on Medicare—including those with kidney disease—the opportunity to save significantly on drug costs.
    • Some may not need Part D and others may risk other health coverage by joining a Part D plan (employer, COBRA, Medicare Advantage)
  • 9. More Key Messages
    • Most info is for the “average” person with Medicare, but www.kidneydrugcoverage.org has kidney-specific info about Medicare Part D.
    • Those who have or choose “kidney-friendly” coverage will save more. Finding and choosing these plans may take some effort.
    • Social workers can help by collecting and saving notices patients receive from government, current plans, Medicare drug plans
  • 10. Kidney Specific Issues
    • Patients must review plans for current and future drugs since health and/or treatment may change
    • Part A drugs will stay Part A
    • Part B drugs (immunosuppressants, EPO, Vitamin D, etc.) will stay Part B
    • Part B and Part D do not coordinate
    • Most of our patients will hit coverage gap; plan for ways to help those in need
      • Apply for Medicare Savings Programs
      • Meet spenddown 9/1-12/31 any year
      • Apply for SPAP, charities, check with drug companies
  • 11. Transplant Specific Issues
    • Although Part D formularies must only have 2 drugs per class, they must have “all or essentially all” immunosuppressants
      • Covered under Part B if patient meets criteria
      • Covered under Part D if on formulary and patient does not meet Part B criteria
    • Transplant patients with ESRD only Medicare can have Medicare and Part D 36 months
    • Transplant patients with Medicare can keep Medicare and Part D indefinitely if they have Medicare due to age or disability
  • 12. Warnings!
    • Patients with COBRA can lose COBRA by signing up for Medicare to get Part D ( general materials have no warnings about this )
    • Patients with Medicare Advantage (HMO, PPO) will lose MA health plan by joining a stand-alone Part D plan (applications and materials have warnings)
    • Employers may cancel coverage if patient joins a Part D plan. Patients should check with employer before making a decision about Part D. ( CMS is developing a process to report employers who cancel employee coverage .)
    • Employers may urge those with kidney disease to take Part D and drop health coverage. ADA prohibits this if other employees in similar positions can keep coverage. ( Report ADA violations to EEOC .)
  • 13.
    • THE RIGHT INFORMATION AT THE RIGHT TIME
  • 14. PHASE ONE: AWARENESS July-August 2005
  • 15. PHASE TWO: EDUCATION September-October 2005
  • 16. PHASE THREE: ACTION November-December 2005
  • 17. PHASE FOUR: HOW TO MAXIMIZE PRESCRIPTION DRUG BENEFITS IN A MEDICARE PART D PLAN January – March 2006
  • 18. PHASE FIVE: HOW TO PREPARE FOR AND COPE WITH THE COVERAGE GAP April – June 2006
  • 19. ORGANIZATION RESOURCES
    • Communications Resource Kit
    • A Guide to Understanding Medicare Part D
    • Bulletin for staff
    • Low literacy awareness message
    • Web Page/Web Address
    • Teleconference announcement
  • 20. GENERAL PUBLIC RESOURCES
    • Web Page/Web Address
    • Newsletter articles for different stages
    • Low literacy awareness message
  • 21. MEDICARE—HOW IT’S CHANGING TO HELP MORE PEOPLE TELECONFERENCE SERIES
    • * Social Workers * Nurses * Dietitians *
    • * Dialysis * Transplant * MD Offices *
    Filling the Coverage Gap January 17, 2006 Appeals & Grievances December 20, 2005 Exceptions, Coverage Determinations November 15, 2005 Evaluating & Choosing a Plan October 18, 2005 Part D Coordination September 20, 2005 Overview & Low-income Subsidy August 16, 2005
  • 22. TOOLS FOR PROFESSIONALS
    • Internal data collection tools for MD offices, dialysis clinics, and transplant programs
      • Medicare Part D Patient Log
      • Medicare Part D Patient Tracking Form
    • Calendar of Key Medicare Part D Dates to help target the right information at the right time
  • 23. MEDICARE PRESCRIPTION DRUG COVERAGE FOR PEOPLE WITH KIDNEY DISEASE
    • Home Dialysis Patients
    • Home hemodialysis
    • Peritoneal dialysis
    • Transplant Recipients
    • <36 months of discharge
    • 65 or older
    • After 24 Months of SSDI for other than kidney failure
    In-Center Dialysis Patients CKD Stage 1-4 Patient Characteristics Medigap H, I, J Any Medicare only beneficiary
    • Medicare Advantage plan
    • Employer/retiree health plan
    • State Pharmacy Asst Programs
    • Prescription plans
    • State kidney programs
    • Other Low Income Subsidy
    • <135% FPL or <150% FPL
    • Auto-enrolled
    • Dual eligible
    • Facilitated Enrollment
    • SSI or MSP
    Insurance Characteristics
  • 24. EDUCATION FOR PEOPLE WITH KIDNEY DISEASE
    • 4 Brochures for people with Medicare
      • Chronic Kidney Disease
      • In-center Hemodialysis
      • Home Hemodialysis and Peritoneal Dialysis
      • Transplant
  • 25. EDUCATION FOR PEOPLE WITH KIDNEY DISEASE
    • 40 fact sheets for people on Medicare who have kidney disease based on
      • Stage of kidney disease and/or treatment type (4)
      • and
      • Financial and insurance status (10)
  • 26. POSSIBLE FUTURE TOOLS AND FACT SHEETS
    • Exception request template for doctors to request drugs for patients that are not on the formulary or drugs that are at a higher tier
    • Fact sheets for patients, MDs, and kidney care team members on exceptions and appeals and to urge the use of these tactics when needed
    • Fact sheet on how to make the most out of True Out-of-Pocket (TrOOP)
    • “ How-to” for conducting a local kidney-specific Medicare prescription drug coverage workshop
  • 27. KUDOS
    • Thank you for sending the message (from Patient & Family Council listserv). It is the best explanation of the new Medicare Part D prescription plan that I have read and clarifies many points for me.
    • Jeanie, patient
    • Great teleconference.  Thanks for providing these wonderful educational opportunities.
    • Laura, MSW
    • I think NKF could be a prototype for our work with others ! 
    • Janet, CMS
  • 28.
    • Tell your patients and staff about this initiative and www.kidneydrugcoverage.org
    • Encourage your staff and patients to listen to free 30-minute teleconferences
    • Link to www.kidneydrugcoverage.org
    • Tell us what you’ve developed for our links
    • Help us find Medicare Prescription Drug Plans in your region offer “kidney-friendly” formularies
    WE NEED YOUR HELP
  • 29. 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
    • Nabi Biopharmaceuticals
    • 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
    • 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
    • Nabi Biopharmaceuticals
    • 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