RCPA - Rehabilitation and Community Providers Association


Answers for Pharmacies on Medicare Part D
January 31, 2006

The Department of Public Welfare (DPW) prepared a question and answer document for pharmacies in response to reports of pharmacies not filling prescriptions under Medicare Part D in the belief that they would not receive payment. The document, POS Facilitated Enrollment: Pharmacy Q & As, addresses how to receive information about the Wellpoint (Anthem) point-of-service (POS) claims payment process through the Wellpoint pharmacy help desk. It addresses what happens when an individual who is dually eligible for Medicare and Medicaid has used the Wellpoint plan, then voluntary enrolls in a prescription drug plan (PDP), a Medicare Advantage Prescription Drug plan (MA-PD), or a Medicare Advantage Special Needs Plan (MA-SNP). It explains that Wellpoint authorizes only up to a 14-day fill and that refills are permitted if the individual has not enrolled in a plan. Once Wellpoint is informed by the Centers for Medicare and Medicaid Services that the beneficiary is eligible for facilitated enrollment, the individual will be enrolled in a Unicare plan and the POS plan will be terminated. This document addresses claims submitted in error and many other issues. The complete document is available from the link. PCPA members may want to review the document and make it available to local pharmacies where clients are having difficulty obtaining medications.

Please contact Betty Simmonds at PCPA with questions.

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