Final - Low Income Toolkit 0106

Auto-Assigned, Low Income
Dual Eligible Beneficiaries –
Florida State
Communication Tool Kit
January 2006
FINAL –1/3/2006
Background
Beginning January 1, 2006, Medicare beneficiaries who are also eligible for Medicaid benefits, referred to
as “dual eligibles,” will begin receiving their primary prescription drug coverage through the new
Medicare prescription drug program, instead of their state’s Medicaid program. Because this population
generally has more complex health conditions and use more prescription drugs than other Medicare
beneficiaries, full-benefit dual eligibles were automatically assigned to a qualifying prescription drug
plan, chosen at random by Medicare, to ensure they do not experience any disruption as their coverage
transitions from Medicaid to Medicare. Dual eligibles were informed by the Center for Medicare and
Medicaid Services (CMS) about the prescription drug plan to which they were assigned in November.
For many dual eligibles, the plan to which they were assigned will best meet their prescription drug
needs, but like all people with Medicare they have the right to choose their own drug plan. Therefore, it
is important that dual eligibles receive accurate, clear and meaningful information about other Medicare
prescription drug plans available to them in their state. To that end, several states worked with an
external vendor to develop letters to inform dual eligibles of alternative Medicare prescription drug plans
that would best meet their needs. The letters, sent in December, do so by matching the medications and
pharmacies they have recently used with those offered by a particular plan, enabling beneficiaries to make
a comparison.
UnitedHealth Group shares an interest with states to ensure all Medicare beneficiaries have access to
accurate and helpful information about their Medicare prescription drug plan options. That is why we
have worked with the federal government, state Medicaid offices and plan providers to ensure these
important letters are clear and that the data the vendor used to develop them accurately reflects plans’
offerings.
These key messages and Q&A are designed to support spokespeople engaged in discussions in explaining
what Part D means for dual eligibles and how UnitedHealth Group is working with federal and state
officials, as well as private businesses to ensure the information needed to guarantee their smooth
transition to Part D is clear and accurate, and does not foster confusion.
The intended audience for this material is three-fold: Media, key influencers and consumers (in general).
Specific pieces are marked according to their intended audience.

Auto-Assigned, Low Income Dual Eligible Beneficiaries
Florida State – Communication Tool Kit
Final – January 3, 2005
Page 2 of 24
Key Messages – Media (Not for External Distribution)
Medicare’s new prescription drug benefit will help bridge a major gap in American
healthcare and provide a much-needed safety net, especially for dual eligible beneficiaries.
• Approximately 6 million Americans are fully dual eligible for Medicare and Medicaid. They
receive health care benefits both from the federal government and from their state Medicaid
program.
• As of January 1, their primary pharmacy coverage is through a Medicare prescription drug
plan. In addition to Medicare Part D, most states will provide dual eligibles with “wrap-
around” benefits for specific drugs not covered by Medicare, or to cover the cost of Part D
drug plan co-payments.
• Dual eligibles generally have more complex health needs than other Medicare beneficiaries
and use multiple prescription drugs.
• Those with multiple prescriptions, several chronic diseases, and high annual drug expenses
can participate in special medication therapy management consultations geared to help
prevent adverse drug reactions ensure the best results.
UnitedHealth Group is working hard to bring high-quality, affordable drug coverage to all
Americans, including the millions of dual eligible beneficiaries. We are pleased to be
working with the federal government, state Medicaid offices and plan providers to
guarantee dual eligibles enjoy a smooth transition to the Medicare prescription drug
benefit. This is consistent with our mission to bridge gaps in the health care system.
• UnitedHealth Group made the decision to offer the benefit based on our long-standing
commitment to the millions of older Americans we serve, and we appreciate this opportunity
to assist those who need help in combating the high costs of prescription drugs.
• We are using our long experience with Medicare to offer a prescription drug plan that is
affordable, simple in design, and offers the high quality that consumers deserve.
• Ovations, the business unit of UnitedHealth Group that operating the Medicare Prescription
Drug plan, is the largest and most recognized business dedicated to the senior market,
serving more than five million older Americans. We offer prescription drug coverage in all
50 states. In fact, we insure 50% of those beneficiaries with prescription drug coverage.
• Ovations has a strong history of working on behalf of older Americans to deliver high-
quality, affordable prescription drug programs. Offering this benefit is consistent with our
mission to bridge the gaps in the healthcare system and offer older Americans broad benefits
and services tailored to their individual needs.

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The federal government, state Medicaid offices and plan providers are collaborating closely
to ensure a safe, smooth and appropriate transition of the dual eligible population from
Medicaid to Medicare prescription drug coverage.
• CMS recently outlined its key objectives to delivering on the promise of making the
transition from Medicaid to Medicare prescription drug coverage seamless and efficient.
• All plan providers must have Medicare-approved Part D transition plans in place that
anticipate potential issues and support a seamless implementation.
• State programs are sending their enrollees information to explain how drug coverage will be
coordinated between Medicare and Medicaid.
• If a beneficiary visits a pharmacy and demonstrates that they are Medicaid and Medicare
eligible, but not yet enrolled in a Part D plan, Medicare has created a system where the
beneficiary can leave the pharmacy with their prescriptions and a drug plan provider. The
plan provider will immediately follow up to validate eligibility and facilitate enrollment into
a Part D plan.
Dual eligibles have the right to choose their own drug plan. For many, the plan to which
they were assigned will best meet their prescription drug needs. However, it is important
that dual eligibles receive information about other Medicare prescription drug plans
available to them in their state. Several states are working to develop letters that will help
dual eligibles determine which Medicare prescription drug plan best meets their needs.
• For many dual eligibles the plan to which they were assigned will best meet their prescription
drug needs, but like all people with Medicare they have the right to choose their own drug
plan. Therefore, it is important that dual eligibles receive accurate, clear and meaningful
information about other Medicare prescription drug plans available to them in their state.
• UnitedHealth Group shares an interest with states to ensure all Medicare beneficiaries have
access to accurate and helpful information about their Medicare prescription drug plan
options.
• Several states have been working with a outside vendor to develop letters to inform dual
eligibles of alternative Medicare prescription drug plans that would best meet their needs
should they choose to switch.
• The letters, sent by the state of Florida, do so by matching the medications and pharmacies
they have recently used with those offered by a particular plan, enabling beneficiaries to
make a comparison.
• UnitedHealth Group worked with the federal government, state Medicaid offices and plan
providers to ensure the data used to develop this important letter accurately reflects plans’
offerings.

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UnitedHealth Group is working with advocacy groups, community organizations and the
states to support dual eligibles as they make a smooth transition from Medicaid to
Medicare prescription drug coverage.
• UnitedHealth Group has been nationally recognized as Part D innovator and leader, both for
its range of prescription drug plans and for its Part D consumer education programs.
• More than 500,000 dual eligibles have already been auto-assigned to Part D plans offered by
UnitedHealth Group.
• We are collaborating with several groups to help auto-assigned dual eligibles and their
caregivers learn what Part D means for them.
• We have created an easy-to-use resource guide specifically tailored for dual eligibles who
have been auto-assigned.
• It’s essential that all beneficiaries have the tools and information they need to get the most
from their prescription drug coverage, and we’re proud to be helping in this national outreach
effort.
# # #

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Potential Q&A – Media (Not for External Distribution)
Q1. What % of dual eligibles does UnitedHealth Group have in its plans?
There are approximately 6.3 million full benefit dual eligible beneficiaries in the U.S. today. They
were automatically assigned to a qualifying prescription drug plan, chosen at random by Medicare,
to ensure they do not experience any disruption as their coverage transitions from Medicaid to
Medicare. UnitedHealth Group was assigned just over 580,000 across the nation and 54,254 in the
state of Florida. They have the right to switch to another plan and we fully support this freedom of
choice.
Q2. Why are dual eligible beneficiaries being assigned a drug plan?
Dual eligibles generally have more complex health conditions than other Medicare beneficiaries and
use more prescription drugs. Beginning January 1, 2006, full benefit dual eligibles will begin
receiving their primary prescription drug coverage through the new Medicare prescription drug
program, instead of their state’s Medicaid program. They were automatically assigned to a drug plan
to ensure they would experience no interruption in coverage during the Part D transition.
Q3. What are you doing to ensure dual eligible individuals understand how Part D applies to
them?
UnitedHealth Group has been nationally recognized as Part D innovator and leader, both for our
customer-centered drug plans and for our Part D education programs. We are working with
advocacy groups, community organizations, physicians, pharmacists, nursing administrators and
other providers, CMS and the states to help auto-assigned dual eligibles and their caregivers learn
what Part D means for them. We have created an easy-to-use resource guide specifically tailored for
people who have been auto-assigned, along with Q&As and other materials that are being used as
part of our ongoing national outreach campaign.
Q4. How were duals assigned to, and informed of, their plan assignment?
Dual eligibles were randomly assigned a plan in October by Medicare and received a letter with
their plan assignment. Plans are providing additional information to their enrollees, including
details about using the plan and how drugs are covered.
Q5. Can enrollees choose a different prescription drug plan?
Yes. All people with Medicare, including those who were auto-assigned, have the right to choose
their own drug plan. Dual eligibles can change drug plans throughout the year, up to once a month,
as long as they are receiving Medicare and Medicaid. If an enrollee wants to keep their assigned
plan, there is nothing they need to do.

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Q6. Why was it necessary for UnitedHealth Group to work on a letter coming from the state to
dual eligibles – was there something wrong with the letters?
UnitedHealth Group shares an interest with the state and federal governments to ensure all Medicare
beneficiaries have access to accurate and helpful information about their Medicare prescription drug
plan options. That is why we along with several other health plan providers worked with the federal
government and state Medicaid offices to ensure these important letters are clear and that the data
used to develop them accurately reflects plans’ offerings.
Q7. What is being done to ensure that dual eligibles’ transition to Medicare Part D goes
smoothly?
The Federal government has taken numerous steps, working with state governments and plan
providers to ensure dual eligibles – who are often vulnerable from a health as well as financial
standpoints – do not experience interruption in their prescription drug coverage:
• CMS recently outlined its key objectives to delivering on the promise of making the transition
from Medicaid to Medicare prescription drug coverage seamless and efficient.
• All plan providers must have Medicare-approved Part D transition plans in place that anticipate
potential issues and support a seamless implementation.
• If a beneficiary visits a pharmacy and demonstrates that they are Medicaid and Medicare eligible,
but not yet enrolled in a Part D plan, Medicare has created a system where the beneficiary can
leave the pharmacy with their prescriptions and a drug plan provider. The plan provider will
immediately follow up to validate eligibility and facilitate enrollment into a Part D plan.
Q8. How is UnitedHealth Group specifically helping their assigned dual eligibles through the
transition?
Our Part D plans were built with the needs of dual eligibles in mind and are designed to mitigate any
disruption in their prescription drug coverage. Our list of drugs exceeds federal recommendations
and includes virtually every drug covered under Part D, including thousands of brand name and
generic medications. We have responsive exception procedures that provide access as needed to
brand name versions of generic drugs, if the branded drug is required.
For the very small number of drugs where plan authorization is required before a prescription is
filled — just 46 out of our entire formulary — enrollees can receive a five-day emergency supply
while coverage determination is being made. Our extensive pharmacy network includes more than
50,000 retail stores across the country, optional mail order services, long-term care pharmacies, and
specialty and community pharmacies, providing convenient access for enrollees.
Q9. What happens to dual eligibles whose assigned plans do not cover all their drugs?
All plans must fill all dual eligibles’ prescriptions for one month, even if the drug is not covered. In
addition, all plan providers are required to have Medicare-approved Part D transition plans in place
that anticipate potential issues and support a seamless implementation. Our transition plan is tied to

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our formulary and benefit structure and will give all new enrollees access to virtually all medication
entities covered under Part D. Key features:
• Formulary exceeds federal recommendations, includes virtually every drug covered under Part D,
including thousands of brand name and generic medications; specially tailored to population.
• For drugs not covered, we’ll work with enrollees (and their physicians) to find other covered drugs
that are equal to their current medication; we have responsive exception procedures that provide
access as needed to brand name versions of generic drugs, if the branded drug is required.
• Five-day emergency supply for very small number of drugs (just 46 out of our entire formulary)
where plan authorization or step therapy required while coverage determination being made.
• Extensive pharmacy network of more than 50,000 retail stores nationwide, mail order services,
long-term care pharmacies, and specialty and community pharmacies, provides convenient
access.
Also, CMS requires all plans to offer those with multiple prescriptions, several chronic diseases, and
high annual drug expenses special medication therapy management consultations geared to help
prevent adverse drug reactions ensure the best results.
Finally, many states will provide dual eligibles with “wrap-around” benefits for specific drugs not
covered by Medicare, or to cover the cost of Part D drug plan co-payments. In fact, for dual eligibles,
CMS requires that in each state Medicare Part D continue to cover all drugs currently covered by that
state’s Medicaid program even if it falls into the limited categories of drugs not covered by Part D,
such as benzodiazapenes.
Q10. How is UnitedHealth Group participating in Part D?
We are offering a broad range of Part D plans across the country and in the U.S. territories,
including integrated Medicare Advantage plans with built-in drug coverage (MA-PDs), stand-alone
prescription drug plans under the AARP and UnitedHealthcare brands (PDPs), and dual eligible
and Institutional Special Needs Plans.
# # #

Page 8 of 24
Key Messages – Key Influencers (To be used with and by Physicians,
Pharmacists and Community-based Groups)
Medicare’s Part D prescription drug plans will help bridge a major gap in American
healthcare and provide a much-needed safety net, especially for dual eligible beneficiaries.
• Approximately 6 million Americans are fully dual eligible for Medicare and Medicaid. They
receive health care benefits both from the federal government and from their state Medicaid
program.
• Today, dual eligibles have their drug coverage through Medicaid. Starting January 1, 2006,
they will receive their primary pharmacy coverage through a Medicare prescription drug
plan.
• In addition to Part D, most states will provide dual eligibles with “wrap-around” benefits for
specific drugs not covered by Medicare, or to cover the cost of Part D drug plan co-
payments.
• Dual eligibles generally have more complex health needs than other Medicare beneficiaries
and use multiple prescription drugs. That’s why it is especially important to mitigate any
disruption in their drug coverage during the Part D transition.
The vast majority of dual eligibles have already been enrolled in a Part D plan, with the
goal of making Part D a smooth, well-coordinated event.
• To ensure that they have continuous drug coverage, dual eligibles were randomly assigned by
Medicare to a drug plan in their area and notified of that assignment in October.
• Medicare providers are proactively contacting enrollees with details about using their plan
and how drugs are covered.
• If an enrollee wants to keep their assigned plan, there is nothing they need to do.
• All people with Medicare, including those who were auto-assigned, do have the right to
choose their own drug plan.
• Dual eligibles can change drug plans throughout the year, up to once a month, as long as they
are receiving Medicare and Medicaid.
Medicare’s prescription drug plans reflect the unique needs of dual eligible beneficiaries.
• Dual eligibles have no premiums for their Medicare drug plans, no deductibles or coverage
gaps, and pay very little or nothing at all for almost all prescriptions.
• The most a dual eligible will pay at the pharmacy is $5 for each medication, each time the
prescription is filled.
• Full dual eligibles who live in nursing homes are completely subsidized by Medicare and pay
nothing out of pocket for their drug coverage.

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• If a drug is not covered, plans will work with enrollees and their physicians to find other
covered drugs that are equal to a member’s current medication, helping to maximize their
Medicare drug coverage.
• Medicare drug plans have extensive pharmacy networks and offer valuable consumer
education, including up-front drug safety checks to ensure their medications are safe and
appropriate.
• Plan enrollees can participate in medication therapy management consultations. In these
one-on-one meetings, pharmacists will review all of an enrollee’s current medications,
explain how they work, and confirm how to take those medications for the best results.
The federal government, state Medicaid offices and plan providers are collaborating closely
to make Part D successful.
• All plan providers must have Medicare-approved Part D transition plans in place that
anticipate potential issues and support a seamless implementation.
• Individual states are helping dual eligible and low income beneficiaries determine which
drug plan best fits their needs. For example, in Florida these beneficiaries are receiving a
letter that lists available drug plans in the state and matches the medications and pharmacies
beneficiaries use with those offered by the plans.
• If a beneficiary visits a pharmacy and demonstrates that they are Medicaid and Medicare
eligible, but not yet enrolled in a Part D plan, Medicare has created a system where the
beneficiary can leave the pharmacy with their prescriptions and a drug plan provider. The
plan provider will immediately follow up to validate eligibility and facilitate enrollment into
a Part D plan.
UnitedHealth Group’s Part D plans were built with the needs of dual eligibles in mind and
are designed to mitigate any disruption in their prescription drug coverage.
• Our list of drugs exceeds federal recommendations and includes virtually every drug covered
under Part D, including thousands of brand name and generic medications.
• We have responsive exception procedures that provide access as needed to brand name
versions of generic drugs, if the branded drug is required.
• For the very small number of drugs where plan authorization is required before a prescription
is filled — just 46 out of our entire formulary — enrollees can receive a 5 day emergency
supply while coverage determination is being made. Expedited requests take no more than
24 hours, and standard requests are no more than 72 hours.
• Our extensive pharmacy network includes more than 50,000 retail stores across the country,
optional mail order services, long-term care pharmacies, and specialty and community
pharmacies.

Page 10 of 24
Additionally, UnitedHealth Group is working with advocacy groups, community
organizations and the states to support auto-assigned dual eligibles during the Part D
transition.
• UnitedHealth Group has been nationally recognized as Part D innovator and leader, both for
its range of prescription drug plans and for its Part D consumer education programs.
• More than 500,000 dual eligibles have already been auto-assigned to Part D plans offered by
UnitedHealth Group.
• We are collaborating with several groups to help auto-assigned dual eligibles and their
caregivers learn what Part D means for them.
• We have created an easy-to-use resource guide specifically tailored for dual eligibles who
have been auto-assigned.
• It’s essential that all beneficiaries have the tools and information they need to get the most
from their prescription drug coverage, and we’re proud to be helping in this national outreach
effort.
# # #

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Potential Q&A – Key Influencers
Q1. What is the Medicare prescription drug program?
This federally-funded, privately administered program was created as part of the Medicare
Modernization Act of 2003. It is designed to lower out-of-pocket prescription drug costs
and expands access to safe, affordable medications for millions of underinsured
Americans.
Q2. Why is Medicare Part D important?
Medicare’s new prescription drug plans will help bridge a major gap in American
healthcare and provide a much-needed safety net, especially for beneficiaries who use
multiple prescription drugs.
Q3. What does it mean for people who have Medicare and Medicaid?
Approximately 6 million Americans are fully dual eligible and receive health care benefits
from both Medicare and Medicaid. Today, dual eligibles have their drug coverage through
Medicaid. Starting January 1, 2006, they will receive their primary pharmacy coverage
through a Medicare prescription drug plan.
Q4. When does the Medicare drug program begin?
The new Medicare prescription drug plans begin January 1, 2006 for people who enroll by
December 31, 2005. On that date, dual eligibles are covered under Medicare for most of
their prescription drugs.
Q5. Will Medicaid cover any medications for dual eligibles, once their Medicare plan
starts?
Most states will offer some limited “wrap-around” coverage for specific drugs not covered
by Medicare, or to cover the cost of drug plan co-payments.
Dual eligibles generally have more complex health conditions than other Medicare
beneficiaries and use more prescription drugs. They were automatically assigned to a drug
plan to ensure they would have continuous drug coverage during the Part D transition.
Yes. All people with Medicare, including those who were auto-assigned, have the right to
choose their own drug plan. Dual eligibles can change drug plans throughout the year, up
to once a month, as long as they are receiving Medicare and Medicaid.

Page 12 of 24
Dual eligibles were randomly assigned a plan in October by Medicare and received a letter
with their plan assignment. Plans are providing additional information to their enrollees,
including details about using the plan and how drugs are covered.
Q9. Does an assigned enrollee have to take any action?
No. If an enrollee wants to keep their assigned plan, there is nothing they need to do.
Q10. Can enrollees change plans after their initial enrollment?
Yes. Dual eligibles are allowed to change drug plans at any time, as long as they stay
enrolled in both Medicare and Medicaid.
Q11. How can dual find out what their other plan options are?
Individual states are helping dual eligible and low income beneficiaries determine which
drug plan best fits their needs. For example, in <Florida> these beneficiaries are receiving
a letter that lists available drug plans in the state and matches the medications and
pharmacies beneficiaries use with those offered by the plans.
Q12. Is participation in the prescription drug program required?
No, it is a voluntary program. But, if a dual eligible beneficiary does not join a Medicare
drug plan, they risk losing valuable prescription drug coverage.
Q13. Are other Medicaid benefits affected by Part D?
No. A dual eligible’s other Medicaid benefits stay the same during this transition. The
only benefit that changes is their primary pharmacy coverage, which moves to Medicare.
Q14. What are the costs to an enrollee of a prescription drug plan?
Dual eligibles have no premiums for their Medicare drug plans, no deductibles or coverage
gaps, and pay very little or nothing at all for almost all prescriptions. The most a dual
eligible will pay at the pharmacy is $5 for each medication, each time the prescription is
filled. Full dual eligibles who live in nursing homes are completely subsidized by
Medicare and pay nothing out of pocket for their drug coverage.
Q15. Are there other advantages to participating in a Medicare drug plan?
Medicare drug plans have extensive pharmacy networks and offer valuable consumer
education, including up-front drug safety checks. Whenever an enrollee fills a
prescription, their pharmacy will confirm that the drug is safe and appropriate for the
enrollee. The pharmacy can also explain how to take medications for the best results.

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Q16. How does the new coverage compare with what duals have today?
Each person’s situation is unique, depending on which state they live in and that state’s
current prescription drug benefit. Because dual eligibles have very few costs and may
receive supplemental drug coverage from their state for Medicare-excluded drugs, along
with extra services and education from their pharmacy, their drug coverage will continue to
be a valuable part of their overall health care benefits.
Q17. Do the Medicare plans cover all types of drugs?
While these plans cover thousands of brand-name and generic medications, there are a few
types of drugs that have excluded by Medicare. Some of the excluded drugs include
benzodiazepines (typically used for panic disorders and anxiety), barbiturates (usually
sedatives and pain management drugs), prescription drugs for coughs and colds,
prescription vitamins, and over-the-counter medications.
Q18. What if the drug an enrollee takes is not covered?
If a drug is not covered, plans will work with enrollees and their physicians to find other
covered drugs that are equal to a member’s current medication, helping to maximize a
member’s Medicare drug coverage.
Q19. What are drug plan providers doing to help enrollees though the transition to Part D?
All plan providers must have Medicare-approved Part D transition plans in place by
January 1, 2006, that anticipate potential issues and support a smooth implementation.
Some of the key elements of those plans include: offering a broad list of covered drugs
with multiple options in each drug class, clearly defined exception procedures, and close
collaboration with the states.
including integrated Medicare Advantage plans with built-in drug coverage (MA-PDs),
stand-alone prescription drug plans under the AARP and UnitedHealthcare brands (PDPs),
and dual eligible and Institutional Special Needs Plans.
# # #

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Proactive Transition Planning for Auto-Enrolled Dual Eligibles
(For Use with states, nursing homes and LTC Pharmacies – distribution possible)
Dual Eligible Part D Transition Planning
More than 500,000 dual eligibles have been auto-assigned to a UnitedHealth Group Part D plan,
and we are working closely with CMS and the states to create a smooth transition for these
enrollees. Our Part D plans were built with the needs of dual eligibles in mind and are designed
to mitigate any disruption in their prescription drug coverage. Key plan elements that support a
seamless Part D transition for enrollees include:
• A single formulary for all our Part D plans that exceeds USP recommendations and
includes virtually every drug in the therapeutic classes and categories covered under
Medicare Part D, including thousands of brand name and generic medications. Our
transition plan is tied to our formulary and benefit structure and will give all new
enrollees access to virtually all medication entities covered under Part D.
• Responsive exception procedures that provide access as needed to multi-source brand
name drugs. The only Part D covered drugs not included on our formulary are multi-
source brand drugs. These are the branded versions of drugs for which an exact chemical
equivalent is available in the same strength and dosage forms. For each multi-source
brand we offer the exact generic copy on our formulary. Multi-source brand drugs are
also available through an exceptions process. In addition, a limited number of multi-
source brand drugs are included on our formulary for a narrow therapeutic index such as
those relating to blood thinning and thyroid hormone supplementation.
• Prior authorization and step therapy requirements for a very small number of drugs.
Prior authorization is needed for only 41 medications, less than 0.2% of claims based on
our experience with senior populations, and step therapy is required for just 5
medications, less than 0.5% of claims based on our experience with senior populations.
Enrollees may receive a 5-day emergency supply for a number of these medications at the
pharmacy while coverage determination is made, which takes no more than 24 hours for
an expedited request or 72 hours for a standard request.
• Small or no co-pays for any of the drugs on our formulary. Our tiered benefit structure
collapses for full benefit dual eligibles into two tiers: generics and brands.
Institutionalized full benefit dual eligibles have no co-pay. Other full benefit dual
elgibles will have a co-pay of no more than $1 to $3 for a generic and $2 to $5 for a
brand, including specialty drugs.
• A custom clinical structure that has special precautions for drugs dangerous to the frail
and elderly, addresses unique drug delivery needs (such as IV and liquid vs. tablet), and
provides safety checks and one-on-one consultations to avoid negative drug interactions
and educate enrollees about the drugs they take.

Page 15 of 24
• An extensive pharmacy network with more than 50,000 retail stores, optional mail
order services, long-term care pharmacies, and specialty and community pharmacies.
• Ongoing enrollee communication and education, including custom-designed resources
for dual eligibles that explain what Part D is, how it affects them, and how to get the most
from their prescription drug coverage.
# # #

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Resource Guide Cover Letter (Community/advocacy organizations)
3645 Thirlane Road NW
Roanoke, VA 24019-3061
Toll Free 1-866-691-8209
December XX, 2005
<Key Influencer name, title>
<Organization>
<Address>
<City, St zip>
Dear <name>:
The new Medicare Part D prescription drug plans will bring tens of millions of Americans access
to prescription drugs and improve their health. Many people in the communities you serve are
undoubtedly turning to you for help and information about Part D. We wanted to take this
opportunity to provide you with some useful resources and tools that will help you educate one
important group that is experiencing changes in the way they receive drug coverage: individuals
fully eligible for both Medicare and Medicaid.
Beginning January 1, 2006, more than 6 million people fully eligible for both Medicare and
Medicaid (“dual eligible”) nationwide will receive their prescription drug coverage through the
new Medicare prescription drug program rather than their state Medicaid programs. To ensure
that dual eligible beneficiaries would have uninterrupted prescription drug benefits, the federal
government chose to automatically enroll many of these individuals into qualifying health plans
with an option to switch. Many other steps have been taken to ensure a smooth transition.
Dual eligibles generally have more complex health needs than other Medicare beneficiaries and
use multiple prescription drugs, making it important to avoid even minor disruptions in
prescription drug coverage. There have been tremendous efforts on the part of the federal and
state governments, Prescription Drug Plan sponsors and non-profit advocacy organizations to
ensure dual eligibles make a smooth transition to Medicare prescription drug coverage. We hope
that you will join us in this initiative and that the attached materials will make the drug benefit
and its application to dual eligibles simple and easy to understand for everyone.
Included with this letter is a:
Medicare/Medicaid Resource Guide. This guide is for people with limited income and
resources who may have questions about the new Medicare drug benefit. Not only does

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this guide help answer your questions; you can also use it as a resource to hand out to
older Americans to help answer their questions.
Our Resource Guide for Low-Income Individuals is available free of charge and can be ordered
to hand out to constituents or the public. If you would like to order any of these pieces, please
feel free to call Kari Dornisch at 952-936-6329.
If you have any additional questions <or are interested in having someone talk to you or your
constituents>, please call Nancy Oliker at 952-936-3268.
I appreciate your time and hope that this material is helpful in your endeavors to educate the
public about Medicare Prescription Drug coverage.
Sincerely,
Anne-Marie Gavel
Vice President, Dual Low Income

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Resource Guide (Community/advocacy organizations)
A pdf of the Resource Guide was included with the original email sent. Please refer to the email for an
approved copy of the guide.

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Blast Fax from WHI to participating Pharmacies
Fax
To: [Click here and type name] From:
Fax: [Click here and type fax number] Date: January 11, 2007
Phone: [Click here and type phone number] Pages: [Click here and type number of pages]
Re: [Click here and type subject of fax] CC: [Click here and type name]
Urgent For Review Please Comment Please Reply Please Recycle
Comments: The start date of Medicare Part D coverage is fast approaching. As of January 1, 2006, dual
eligible individuals (eligible for both Medicaid and Medicare) will receive their prescription drug coverage through
Medicare rather than via their state Medicaid programs. As a measure to ensure that these beneficiaries have
uninterrupted prescription drug benefits, the federal government has chosen to automatically enroll many of
them into qualifying health plans.
Here are some basic facts about the auto-enrollment of dual eligible individuals :
Six Basic Things to Let Dual Eligible People Know:
1. Medicaid Will No Longer Provide Their Prescription Drug Coverage. Beginning January 1, Medicare will begin to pay
for outpatient prescription drugs.
2. Their Drug Benefits Are Changing. Part D plans have new sets of rules, co-pays for drugs filled and the drugs that it
covers.
3. Beneficiaries May Be Charged a Small Co-payment For Their Prescriptions. They may need to pay a small co-
payment, or nothing at all, for prescriptions (depending on the extra help they receive from Medicare).
4. Beneficiaries Need to Make Sure Their Pharmacies Are Contracted by Their Drug Plan. Beneficiaries will receive a
listing of the pharmacy network from their Medicare drug plan provider. We will need your help in making sure they understand
this.
5. Make Sure the Drugs Taken Are On Drug Formulary. Beneficiaries should use the formulary information, along with help
from their doctor and pharmacist, to ensure their drug needs are met by their plan. This may entail looking at therapeutic
alternatives (e.g., other brand name, generics).
6. If you have beneficiary that is unassigned, please have them contact 1-866-691-8209.
Resources will be available to you, as an influential contact for Medicare beneficiaries. Expect to see a Medicare Part D
Pharmacy Kit arriving in January. This kit will help address questions that you and/or you customer may have.
Should you have questions, please call our Pharmacist Help Line at 1-888-492-2952.

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Automated Call – Outbound Call Script
Call Purpose: Welcome & Educate Auto Assigns
(This document is currently being reviewed by CMS – Will distribute when approved)
S5820S5805_PDP441 CMS XX/XXXX

Page 21 of 24
Call Center Q&A – Inbound
Q1. What is the Medicare prescription drug program?
This federally-funded, privately administered program was created as part of the Medicare
Modernization Act of 2003. It is designed to lower out-of-pocket prescription drug costs
and expands access to safe, affordable medications for millions of underinsured
Americans.
Q2. Why is Medicare Part D important?
Medicare’s new prescription drug plans will help bridge a major gap in American
healthcare and provide a much-needed safety net, especially for beneficiaries who use
multiple prescription drugs.
Q3. What does it mean for people who have Medicare and Medicaid?
Approximately 6 million Americans are fully dual eligible and receive health care benefits
from both Medicare and Medicaid. Today, dual eligibles have their drug coverage through
Medicaid. Starting January 1, 2006, they will receive their primary pharmacy coverage
through a Medicare prescription drug plan.
Q4. When does the Medicare drug program begin?
The new Medicare prescription drug plans begin January 1, 2006 for people who enroll by
December 31, 2005. On that date, dual eligibles are covered under Medicare for most of
their prescription drugs.
Q5. Will Medicaid cover any medications for dual eligibles, once their Medicare plan
starts?
Most states will offer some limited “wrap-around” coverage for specific drugs not covered
by Medicare, or to cover the cost of drug plan co-payments.
Dual eligibles generally have more complex health conditions than other Medicare
beneficiaries and use more prescription drugs. They were automatically assigned to a drug
plan to ensure they would have continuous drug coverage during the Part D transition.
Yes. All people with Medicare, including those who were auto-assigned, have the right to
choose their own drug plan. Dual eligibles can change drug plans throughout the year, up
to once a month, as long as they are receiving Medicare and Medicaid.

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Dual eligibles were randomly assigned a plan in October by Medicare and received a letter
with their plan assignment. Plans are providing additional information to their enrollees,
including details about using the plan and how drugs are covered.
Q9. Does an assigned enrollee have to take any action?
No. If an enrollee wants to keep their assigned plan, there is nothing they need to do.
Q10. Can enrollees change plans after their initial enrollment?
Yes. Dual eligibles are allowed to change drug plans at any time, as long as they stay
enrolled in both Medicare and Medicaid.
Q11. How can duals find out what their other plan options are?
Individual states are helping dual eligible and low income beneficiaries determine which
drug plan best fits their needs. For example, in <Florida> these beneficiaries are receiving
a letter that lists available drug plans in the state and matches the medications and
pharmacies beneficiaries use with those offered by the plans.
Q12. Is participation in the prescription drug program required?
No, it is a voluntary program. But, if a dual eligible beneficiary does not join a Medicare
drug plan, they risk losing valuable prescription drug coverage.
Q13. Are other Medicaid benefits affected by Part D?
No. A dual eligible’s other Medicaid benefits stay the same during this transition. The
only benefit that changes is their primary pharmacy coverage, which moves to Medicare.
Q14. What are the costs to an enrollee of a prescription drug plan?
Dual eligibles have no premiums for their Medicare drug plans, no deductibles or coverage
gaps, and pay very little or nothing at all for almost all prescriptions. The most a dual
eligible will pay at the pharmacy is $5 for each medication, each time the prescription is
filled. Full dual eligibles who live in nursing homes are completely subsidized by
Medicare and pay nothing out of pocket for their drug coverage.
Q15. Are there other advantages to participating in a Medicare drug plan?
Medicare drug plans have extensive pharmacy networks and offer valuable consumer
education, including up-front drug safety checks. Whenever an enrollee fills a
prescription, their pharmacy will confirm that the drug is safe and appropriate for the
enrollee. The pharmacy can also explain how to take medications for the best results.
Q16. How does the new coverage compare with what duals have today?
Each person’s situation is unique, depending on which state they live in and that state’s
current prescription drug benefit. Because dual eligibles have very few costs and may

Page 23 of 24
receive supplemental drug coverage from their state for Medicare-excluded drugs, along
with extra services and education from their pharmacy, their drug coverage will continue to
be a valuable part of their overall health care benefits.
Q17. Do the Medicare plans cover all types of drugs?
While these plans cover thousands of brand-name and generic medications, there are a few
types of drugs that have excluded by Medicare. Some of the excluded drugs include
benzodiazepines (typically used for panic disorders and anxiety), barbiturates (usually
sedatives and pain management drugs), prescription drugs for coughs and colds,
prescription vitamins, and over-the-counter medications.
Q18. What if the drug an enrollee takes is not covered?
If a drug is not covered, plans will work with enrollees and their physicians to find other
covered drugs to replace a member’s current medication, helping to maximize a member’s
Medicare drug coverage.
Q19. What are drug plan providers doing to help enrollees though the transition to Part D?
All plan providers must have Medicare-approved Part D transition plans in place by
January 1, 2006, that anticipate potential issues and support a smooth implementation.
Some of the key elements of those plans include: offering a broad list of covered drugs
with multiple options in each drug class, clearly defined exception procedures, and close
collaboration with the states.
including integrated Medicare Advantage plans with built-in drug coverage (MA-PDs),
stand-alone prescription drug plans under the AARP and UnitedHealthcare brands (PDPs),
and dual eligible and Institutional Special Needs Plans.
Q21. How is UnitedHealth Group specifically helping their assigned dual eligibles through
the transition?
Our Part D plans were built with the needs of dual eligibles in mind and are designed to
mitigate any disruption in their prescription drug coverage. Our list of drugs includes
thousands of brand name and generic medications. We have responsive exception
procedures that provide access as needed to brand name versions of generic drugs, if the
branded drug is required.
For the very small number of drugs where plan authorization is required before a
prescription is filled — just 46 out of our entire formulary — enrollees can receive a 5 day
emergency supply while coverage determination is being made. Our extensive pharmacy
network includes more than 50,000 retail stores across the country, optional mail order
services, long-term care pharmacies, and specialty and community pharmacies, providing
convenient access for enrollees.

Page 24 of 24
Q22. How can a beneficiary confirm whether they are dual eligible?
The Social Security Administration (1-800-772-1213, TTY 1-800-325-0778) can help with
questions about eligibility for and assistance with costs of a Medicare drug plan. For
Medicaid questions, beneficiaries can call the Medicare Helpline (1-800-MEDICARE – 24
hours a day/7 days a week) and ask the operator for the telephone number for their state’s
Medical Assistance or Medicaid office.
# # #

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