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Please scroll down to the bottom of the page for downloadable materials and helpful links. Please note the number in bracket next to a bold item in the page content corresponds to the downloadable item or link at the bottom of the page. "HPMS" Guidance to Plans: From the "HPMS Guidances" link below, access Medicare prescription drug (Part D) guidance materials distributed to the plans through the Health Plan Management System (HPMS). {21} 2007 Drug Plan Options: At the link below, you can access the stand-alone prescription drug plans and the Medicare Advantage plans. {19}2007 Transition Guidance for Part D Plan Sponsors The Centers for Medicare & Medicaid Services released the final 2007 Transition Guidance for Part D sponsors, which establishes a minimum set of standards for Part D plan sponsor transition policies. To address the needs of individuals who are stabilized on certain drug regimens when they join a plan, Part D plans are required to establish an appropriate transition process for new enrollees who are transitioning to a Part D plan from other prescription drug coverage – including other Part D plans – and whose current drug therapies may not be included in their new Part D plan's formulary, or situations in which enrollees are stabilized on formulary drugs that require prior authorization or step therapy under a plan's utilization management rules. While Part D plans may implement additional step therapy or prior authorization edits during transition, they may do so only if such edits are resolved at the point of sale. Additionally, transition processes must also address cases in which a beneficiary changes their setting of care, for example from a hospital to a home or institutional setting, to provide uninterrupted access to needed drugs. The guidance also recognizes the needs of new full-benefit dual eligibles who may be auto-enrolled in a prescription drug plan who may be unaware of the impact of the prescription drug plan's formulary or utilization management practices on their existing drug regimens. A fact sheet describing the minimum required standards for a Part D sponsor transition process, the 2007 Transition Guidance, and a summary of changes from the 2006 to 2007 guidance can be access by clicking on the link below. {18}Auto and Facilitated Enrollment Guidance
The purpose of the two memos below are to provide information and guidance about the following:
•The first round of facilitated enrollment, effective May 1, 2006
•Effective dates for future auto-enrollment actions
•Retroactive enrollments for full-dual beneficiaries who have voluntarily enrolled in a PDP
•The monthly file of full benefit duals enrolled in MA plans Updated Guidance – Changes to Effective Date and PDP Notice Requirements for Auto-Enrollment and Facilitated Enrollment Updated Guidance – Changes to Effective Date of Medicare Advantage (MA) and 1876 Cost Plan Auto-Enrollments and Notice to Begin Facilitated Enrollment of Other LIS Beneficiaries {17}Home Infusion Therapy Letter This letter provides clarification on Part D benefit for home infusion therapy. {16}CMS Guidance to Plans These two documents were issued to plans on January 6, 2006. One document emphasizes the critical importance of beneficiaries getting their needed first prescriptions filled at the point of sale. The other document explains the expedited processes for application of cost sharing for dually eligible individuals and other low-income beneficiaries. {15}Compliance Letter to Selected Plans A letter to selected PDP plans on Compliance in Providing Appropriate Contacts for Providers {14}Dr.McClellan's Letter to the Plans This letter from Dr. McClellan was sent to the plans on January 18, 2006 and it recaps some of the things that CMS is working with the plans in continuing to serve all beneficiaries effectively and to remain particularly sensitive to the needs of the most vulnerable beneficiaries. {13}Special Needs Plans (SNPs) CMS has posted an updated SNP fact sheet, list of 2006 SNP plans, and several maps that show SNP coverage (penetration) across the country for 2005 and 2006. {12}Memorandum to All Part D Sponsors regarding Pharmacy Transition Policies {11}Auto-Enrollment Crosswalk Provide PDPs' region, contract ID number, BIN, & PCN information. Scroll to bottom of the page for the link. Click on the link and scroll down to Downloads for the Auto-Enrollment Crosswalk. {10}PDPs Government Relations Contact List {9}PDPs Pharmacy Contracting Contact List Scroll to bottom of the page for the link. Click on the link and scroll down to Downloads for the Pharmacy Contracting Contact List. {8}Prescription Drug Coverage Information This link provides general information on the new Medicare prescription drug coverage, such as plans in the area, plan's needed number, or updated Q&As.... {7}Special Needs Plans (SNPs) Updated SNP fact sheet, list of 2006 SNP plans, and several maps that show SNP coverage (penetration) across the country for 2005 and 2006. PRESCRIPTION DRUG PLAN FINDER Available at {6}www.medicare.gov, the Prescription Drug Plan Finder is one of the new resources CMS is now using to help train local partners, such as the State Health Insurance Assistance Programs, senior centers, faith-based organizations and others who will be assisting beneficiaries in learning more about and enrolling in drug plans later this year. The tool will ask questions based on the coverage beneficiaries have now to provide them with tailored plan comparison information based on what is most important to them, including cost, coverage and convenience. Beneficiaries can also get personalized information on particular plans that they think may be a good fit for them. Medicare beneficiaries who don't use the Internet will be able to get the same information by calling 1-800-MEDICARE (800-633-4227). The Plan Finder will ultimately let people check to see if they qualify for extra help paying for a Medicare drug plan, if their employer or union is continuing their current drug coverage or if they are already enrolled in a Medicare Advantage or other Medicare Health Plan or in a Medicare drug plan. As of today, not all of the data is in the plan finder, since the deadline for many employers to submit their applications is Oct. 31 and some applications for those beneficiaries applying for extra help have not been finalized. Drug plans may also update their price and other benefit information as the enrollment period draws closer. {5}Transition Process Guidance This document provides plan sponsors guidance on transition process for new enrollees who are transitioning to Part D from other prescription drug coverage. {4}Long Term Care Guidance This document is provided as guidance to assist Medicare Part D plans in formulating policies for the implementation of CMS requirements regarding pharmacies providing products and services to Long Term Care (LTC) facilities. {3}Provide updates to conditionally approved formularies during an open period in September 2005. {2}Provide marketing guidance for Medicare Advantage and Prescription Drug Plans. The guidelines will allow organizations that offer both Medicare Advantage and Prescription Drug Plans the ability to reference one single-source document. {1}Information for 3rd parties who are interested in contracting with Part D plans.
Page Last Modified: 04/05/2006 12:00:00 AM
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