Medicare Drug Benefit: IFAS Outreach

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Part D

• Medicare Drug BenefitIFAS Outreach
• Traci Brooks, Senior Pharmacy Student
• University of Florida College of Pharmacy
• Carolyn S. Wilken, PhD, M.P.H
• Associate Professor Family Science
• University of Florida
• David M. Angaran MS, FASHP, FCCP
• Clinical Professor of Pharmacy
• University of Florida College of Pharmacy
• IFAS Program
• V3 031606

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Objectives Part I

• Prepare the IFAS county faculty for training and
  supporting Medicare Part D volunteer educators
• Review Medicare Drug Benefit
• Describe the IFAS-Medicare Part D education
  process
• Explain the data collection and patient report
  instruments.
• Demonstrate navigating www.medicare.gov
• Part II - Practice

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History of Medicare

• Medicare 1965
• Part A hospitalization
• Part B Physician visits and some drugs
• Part C (Old HMOs)
• Medicare Drug Benefit 2003
• Medicare Modernization Act
• Medicare Prescription Drug, Improvement and
  Modernization Act of 2003 (Pub l. 108-173)
• Medicare Part D

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Why Sign UP?

• Save Money NOW
• Without With Savings
• Per Year Per Year
• 1,200 874 326
• 2,250 1,136 1114
• 5,100 3,986 1114
• Save Money LATER
• Insurance for the future
• Penalty if you dont
• 1 per month after May 15, 2006
• Plan premium 40.00 YOU PAY 43.20

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Medicare Prescription Drug Providers

• Prescription Drug Plan (PDP)
• Drugs only
• Medicare Advantage Medical Care Drugs
• MA-PD (HMOs) Medicare Advantage-Prescription
  Drug
• PPO-PD Preferred Provider Organization
• PFFS-PD Private Fee for Service
• SNP-PD Special needs plan

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Standard (Minimum) Government Benefit
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Prescription Drug PlansPrivate Companies

• Must offer at least standard benefit
• Can offer more benefit
• Florida PDPs
• 19 companies with 44 different plans
• Monthly premium 10.35 to 104.89
• Most under 50.00 per month
• Deductible 0 to 250.00
• MA-PDs (HMO)
• County Specific

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Choosing Total Cost and Coverage

• Is your drug covered
• Drug Cost
• Co pay and Co-insurance
• Tier
• Category
• Monthly premium
• Yearly deductible
• Doughnut hole coverage
• Mail Service
• Network pharmacy

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Definitions

• Co-Pay
• Fixed amount you pay for each prescription.
  Difference between generic and brand.
• Co-Insurance
• Percentage of the actual sale price.
• 25 of 100 25.00
• 25 of 200 50.00
• Change with price increases

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Definitions (cont)

• Formulary
• List of drugs covered and price category
• Preferred
• Cost you less than NON preferred
• Generic
• An FDA approved version of a Brand drug
• Similar
• Different drug same results
• Lower cost

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Definitions Drug Category

• Tiers
• 1st Tier Generic Drugs
• 2nd Tier Preferred Brand
• 3rd Tier Non Preferred Brand
• Specialty
• In Network and Out of Network
• Each plan may not be offered at all pharmacies.
  Those that offer the plan are in network and
  those that do not offer the plan are out of
  network
• Out of Network pharmacies many times will be more
  expensive for the patient to receive their
  medications

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Excluded Drugs Pay usual retail costs

• There are some drugs that NONE of the PDPs will
  cover.
• Examples of these drugs are
• Valium, diazepam, Xanax
• Anorexia, weight loss, or weight gain drugs
• Fertility drugs
• Drugs for cosmetic purposes or hair growth
• Symptomatic relief of cough and colds
• All Over-the-Counter (OTC) medications

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7 Medication Regimen Tested

• AVANDIA 4 MG TABLET
• CELEBREX 200 MG CAPSULE
• CELEXA 40 MG TABLET
• COZAAR 50 MG TABLET
• GLUCOPHAGE XR 500 MG TAB SA
• NEXIUM 40 MG CAPSULE
• PLAVIX 75 MG TABLET

• Costs cvs.com accessed 022706
• Retail, 30 day supply, for one year.
• 8,210.00 -7,200
• Tested as
• PDP only
• No low income benefit
• Any pharmacy
• Any company
• Florida

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7 Drug Retail Annual Cost Out of your
Pocketcopay premium deductible

• Brand
• 1 Humana 3,755
• 61.70/month
• 2 Humana 3,844.
• 10.35/month
• 3 Humana 3,972
• 20.12/month

• Generic/Similar
• 1 Humana 2,432
• 2 AdvantraRx 3,414
• 3 MedicareRx 3,572
• 8 Humana (10.35/mo)
• 18 Humana (20.12/mo)

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Extra Help Social Security

• Social Security Administration (SSA)
• Single Less than 14,355/Year
• Couple Less than 19,245/Year
• Reduce or eliminate
• Co pay or Coinsurance
• Premium
• Deductible
• Social Security
• www.ssa.gov/prescriptionhelp
• 1-800-772-1213

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Low-Income Benefits Under Part D
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Signing UP May 15,2006 or else

• Annual Enrollment Period for PDPs
• Once a year Nov 15 to Dec 31st.
• On Medicare and Medicaid No option
• All Medicare recipients A, B, Disability
• Dont Sign UP and No Penalty
• Employer retirement
• VA coverage
• Credible Coverage
• Other prescription drug coverage (VA, former
  employee benefits) that meet or exceed the
  requirements of Medicare Part D
• You need to make sure your coverage falls into
  this category