2013 Transition Rights to Medications Under Part D
A Part D sponsor may need to make arrangements to continue to provide necessary drugs to an enrollee via an extension of the transition period, on a case-by case basis, to the extent that his or her exception request or appeal has not been processed by the end of the minimum transition period. It is vital that sponsors give affected enrollees clear guidance regarding how to proceed after a temporary fill is provided, so that appropriate and meaningful transition can be effectuated by the end of the transition period. Until that transition is actually made, however, either through a switch to an appropriate formulary drug, or a decision is made regarding an exception request, continuation of drug coverage is necessary, other than for drugs not covered under Part D.”
Source: nsclc.org
Video: Medicare Part D
Open Enrollment 2013: Medicare Part D Benefits Improve but Premiums an…: aarp.org
False Claims Act Reaches Medicare Part D Preferred Benefit Managers; Case Against Caremark to Proceed
Among the important issues decided by the judge are that: (1) Prescription Drug Event records (PDEs) by Part D PBMs are “claims” under the FCA; (2) the relator/plaintiff properly pled falsity based on a PBM’s false certification of the accuracy, truth, and completeness of its Part D PDEs as well as under a worthless services theory (failure to provide Part D services, including DUR, subjects providers, including PBMs, to FCA liability); and (3) the reverse false claims section of the FCA applies because false Part D claims impact the Part D reconciliation process. Other points of note include an excellent discussion by DOJ in its SOI of why its declination decisions should not be interpreted as a decision on the merits of the case; and the court’s rejection of Caremark’s public disclosure argument, finding that neither the exchange of information covered by a confidentiality agreement in discovery during civil litigation, nor the submission of Part D PDE to CMS is a public disclosure that could jurisdictionally bar relator’s suit.
Source: bostonwhistleblowerlawyerblog.com
Medicare Plan Finder for Health, Prescription Drug and Medigap plans
Between January 1–February 14, if you.
Source: medicare.gov
Choosing a Medicare Part D Prescription Plan
People with arthritis are typically prescribed medications to control symptoms and progression of the disease. For arthritis patients who have qualified for Medicare benefits, there are Medicare Part D prescription plans available. Open enrollment for Medicare plans started October 15, 2012 and ends on December 7, 2012. What does this mean for you? It’s time to review your options, even if you already have a Medicare Part D prescription plan. If you have started new drugs or stopped any that you were taking last year, or if your insurer changed their drug formulary list, you may no longer have the best Medicare Part D plan for you.
Source: about.com
Medicare Part D: A First Look at Part D Plan Offerings in 2013
NOTE: Originally released in October 2012, this data spotlight was updated in November 2012 to reflect revised data from the Centers for Medicare and Medicaid Services.
Source: kff.org
Tips for Navigating Medicare Part D Open Enrollment.
Source: phrma.org
Medicare Part D: It Pays to Shop Around.”
Source: lexisnexis.com
Top Medicare Part D Plan Costs Spike in.
Source: webmd.com
Expert Tips to Simplify Medicare Plan D
Part D Plan is a network pharmacy that offers covered drugs to plan members at lower out-of-pocket costs than what the member would pay at a non-preferred network pharmacy. This can make huge difference in what you’ll pay. For example, Walmart is a preferred pharmacy on multiple plans including the Humana-Walmart Preferred Rx Plan. They provide access to the top ten hypertension drugs for just one cent. So if you’re one of the 70% of Americans over the age of 65 who have high-blood pressure, you can get a month’s worth of the medication you need for just one penny! Just one specific example of how it can pay to do your homework.”
Source: alexisabramson.com