Medicare Part D. Lisa Hart, Pharm.D. Extension Health Specialist UK Cooperative Extension HEEL Program UK College of Pharmacy
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1 Medicare Part D Lisa Hart, Pharm.D. Extension Health Specialist UK Cooperative Extension HEEL Program UK College of Pharmacy 1
2 Medication Use in Older Adults The average number of prescriptions filled for older Americans each year has increased from 18 per person in 1992 to 30 per person in Source: Older Americans 2004: Key Indicators of Well-Being Being. Federal Interagency Forum on Aging Related Statistics. 2
3 Medication Use in Older Adults Costs have increased at the same time that the number of prescriptions have increased In 2000, 17 percent of older adults incurred prescription drug costs of $2,000 or more Source: Older Americans 2004: Key Indicators of Well-Being Being. Federal Interagency Forum on Aging Related Statistics. 3
4 Medicare Part D 42 million people covered by Medicare will now have the option of enrolling in Medicare prescription drug coverage 4
5 How Drug Plans Vary Prescription drugs covered Individual out-of of-pocket expenses Pharmacies included in plan Level of coverage offered For example: Can a participant receive more than the standard level of coverage for a higher monthly premium? 5
6 Considerations for Plan Selection Coverage Cost Convenience Peace of Mind 6
7 Considerations for Plan Selection Coverage Are current prescriptions covered by the plan s s formulary? Plans may have tiered formularies Plans may require a prior authorization 7
8 Considerations for Plan Selection Cost Monthly premium Deductible Co-pay/Co-insurance Coverage gap 8
9 Considerations for Plan Selection Convenience Pharmacies in network Mail order 9
10 Considerations for Plan Selection Peace of mind Possible future needs Avoid penalty for late enrollment 10
11 Plan Selection Questions Questions to ask when selecting a plan: Does the plan cover all of my drugs? What is the monthly premium? Is there a co-pay for each prescription in addition to monthly premium? What is my yearly deductible? Can I use my current pharmacy? Is mail order available? 11
12 Prescription Drugs Included in Medicare Part D Medicare Part D includes most prescription drugs not currently covered under Medicare Part A and Part B. Examples of Part A and Part B drugs currently covered: Drugs administered in a hospital or doctor's office Vaccines and drugs for nebulizers 12
13 Excluded Prescription Medications The following are examples of the types of drugs excluded from Part D by Medicare: Drugs for weight loss or gain Drugs for cosmetic purposes Drugs for relief of simple coughs and colds 13
14 Excluded Prescription Medications Most vitamins and minerals Non-prescription drugs Barbiturates Benzodiazepines 14
15 Plan Formularies Six drug classes of special concern have been specified in which all drugs will be on formulary: 1. Anticancer drugs 2. HIV/AIDS drugs 3. Immunosupressants 4. Antipsychotics 5. Antidepressants 6. Anticonvulsants 15
16 Plan Formularies Must include: at least two drugs within each therapeutic category and class of covered Part D drugs must offer both brand-name name and generic drugs 16
17 Prescription Plan Finder Medicare offers a Prescription Drug Plan Finder Quick Start Guide Tutorial at: materials/quickstart/launcher.html 17
18 Formulary Finder Medicare offers a Formulary Finder to assist in formularyfinder/selectstate.asp 18
19 Important Dates November 15 December 31 every year Person who does not have a Medicare drug plan can join Person who currently has a Medicare drug plan can switch Change effective January 1 19
20 Questions? For more information on the Medicare Part D Prescription Drug Program, please contact: Lisa Hart, Pharm.D. lisa.hart@uky.edu , 2968, ext Or Visit the UK Cooperative Extension HEEL Program Web site at: 20
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