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Resources for Medicare Part D Issues
January 20, 2006

Several “fixes” have been established to resolve some of the many problems that have arisen with Medicare Part D implementation. These have been reported in previous Alerts that are available on the web site. Some additional information that members may find helpful follows.

  • The Centers for Medicare and Medicaid Services (CMS) Plan Finder Tool on the Medicare web site (www.medicare.gov) can help to identify a Medicare beneficiary’s enrollment status. If beneficiaries do not know in which plan they are enrolled, or if they are even enrolled in a plan, providers could try the personalized plan search feature that requires entry of the individual’s Medicare identification information and demographics (www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/Questions.asp).
  • Plan formulary information is available at no cost through Epocrates (www2.epocrates.com).
  • CMS has also created a web-based formulary finder that can be accessed through http://formularyfinder.medicare.gov/formularyfinder/selectstate.asp. The CMS Formulary Finder provides a list of all Part D plans in a given state and links directly to a plan’s home page for a complete formulary. It also provides general information about a plan’s drug utilization and appeals process. In mid-January the CMS Formulary Finder will be linked directly to individual plan formularies.
  • CMS is holding conference calls on Medicare Part D for physicians each week on Tuesday at 2:00 p.m. for about one hour. Call 800-619-2457 with pass code RBDML to participate. This call is intended for physicians and other prescribers, but anyone can dial in. The conference call representative does ask for agency affiliation. There are similar weekly conference calls for pharmacies and long-term care.
  • CMS has begun the Medicare Beneficiary Ombudsman’s Open Door Forum (ODF) (www.cms.hhs.gov/apps/mailinglists/default.asp?audience=4). Daniel J. Schreiner, the ombudsman, coordinates with CMS to oversee beneficiary concerns including appeals, complaints, grievances, and requests for assistance. The purpose of the ombudsman is to ensure that people with Medicare get the information and help they need to understand their Medicare options and to apply their rights and protections. Each ODF will focus on one or two topics, at the ombudsman’s discretion, based on issues that advocacy groups and others bring to his attention. CMS subject matter experts will participate in the ODFs to give status reports and engage in discussion on key issues, as appropriate.
  • Another quick reference document for Medicare Part D issues is the Medicare Part D Quick Response Finder. It was distributed by the Pennsylvania Office of Mental Retardation.

PCPA Members may contact Betty Simmonds with questions about Medicare Part D implementation.

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