RCPA - Rehabilitation and Community Providers Association


Medicare Modernization Act Deadline Approaches
May 9, 2006

The May 15 enrollment deadline for Medicare Prescription Drug Plans (PDP) is rapidly approaching. Those who are eligible for Medicare and have not yet enrolled in a Medicare PDP or a Medicare Advantage Plan or have existing creditable coverage must enroll by May 15 or face penalties if they enroll at a later date. For information and to enroll contact 800-MEDICARE (800-633-4227), TTY: 877-486-2048, or view the Medicare web site (www.medicare.gov).

The Pennsylvania Health Law Project (PHLP) has found that the settlement agreement that extended the transition period for those who were passively enrolled in Medicare Special Needs Plans is being violated. They have received information that medications that were prescribed to individuals before January 1 are being denied, a violation of the settlement agreement. Medical services are also being denied. PHLP requests that individuals contact them at 800-274-3258 if they have had problems with transition and need assistance and information.

Pennsylvania’s Special Pharmaceutical Benefits Program (SPBP) has issued a client notice regarding the interface of SPBP and Medicare Part D. The notice reminds SPBP clients that they must enroll in a Medicare Part D plan by May 15 or risk losing SPBP support. SPBP is the secondary payer after Medicare. SPBP will cover Part D deductibles and co-payments for SPBP covered drugs, but will not cover premiums. SPBP will also cover the "donut hole" for SPBP formulary drugs. SPBP will continue to cover nutritional supplements and over the counter medications for SP1 cardholders and clozaril support services for SP2 and SP23 cardholders. Contact SPBP at 800-922-9384 with questions.

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