Are All Prescription Drugs Covered Under Medicare Drug Plans?
The new Medicare Drug Plans require Part D enrollees who exceed certain income thresholds to pay higher premiums for their medical benefits. Section 3308 revises the current authority to disclose income information to the Health Department for purposes of adjusting the Part B subsidy limitations.
New Cost Cutting Measures
Section 3309 eliminates cost sharing for certain dual eligible individuals receiving care under a home and community-based waiver program who would otherwise require institutional care and hospital commitment. Section 3310 directs the Secretary to require sponsors of prescription Medicare drug plans to utilize specific, uniform techniques for dispensing covered Part D prescribed medications to enrollees who reside in a long-term care facility in order to reduce waste and redundant services associated with 30-day refills.
Required Prescription Drugs in Medicare Drug Plans
Section 3307 authorizes the Secretary to identify classes of clinical prescription and medical therapy concern through rulemaking, including anticonvulsants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants for the treatment of transplant rejection. This bill requires prescription Medicare drug plans and their sponsors to include all medication therapies in these classes of their formularies.
Complaints and Appeals
This bill directs the Secretary to develop and maintain an easy to use complaint system to collect and maintain information on MA-PD plan and prescription drug complaints with the Medicare Drug Plans received by the Secretary until the complaint is resolved or dismissed. Section 3312 requires a prescription drug sponsor to: (1) use a single, uniform exceptions and appeals process for determination of a plan enrollee’s prescription drug coverage or Medicare Drug Plans; and (2) provide instant access to this process through a toll-free number and an Internet website.
Section 3313 of the new bill requires the HHS Inspector General to study and report to the appropriate government agencies on the inclusion in medication formularies of: (1) prescriptions commonly used by dual eligibles; and (2) prescription drug prices and prescription drug plans under Medicare Part D and Medicaid.
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