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Press Release -- November 17, 2005

Tips for Enrolling In Medicare Part D

Denver, CO. The adage "the details are in the fine print" is definitely true for Medicare beneficiaries who are choosing a prescription drug benefit.
To enroll in the new Medicare Prescription Drug benefit that starts January 1, 2006, Medicare beneficiaries must choose between 42 drug plans offered by stand alone prescription drug plans and eight Medicare Advantage (HMO/PPO/PFFS) companies. Enrollment started November 15, 2005 and continues through May 15, 2006 without a penalty.
First and foremost, Medicare beneficiaries should study the formulary or the drugs that are on the approved list. Medicare beneficiaries need to compare the list of their current medications with those that are on the formulary of the drug plan under consideration.
Sometimes the drug may not be on the formulary. Physicians can either select another drug that is on the formulary or write a letter to the prescription drug plan to request an "exception". The company may provide one 30-day supply of the prescription to the Medicare beneficiary (individuals in a nursing home may get a 90 to 120 day supply), giving the physician time to request an exception or write another prescription.
A review of the formularies shows that selected drugs "always require a prior authorization". If a Medicare beneficiary is taking a prescription drug that requires "prior authorization" by one company, but not by another, the individual may want to enroll with the company that does not require prior authorization, justifying medical necessity. This decision may avoid the ongoing need to get "prior authorization" for the drug.
The formulary most likely will contain tiers with different co-pays on each level. For example, AARP has synthroid, a common drug as a Tier 2 drug; while Aetna has synthroid as a Tier 3 drug. A Tier 2 drug on the AARP formulary has a different co-payment, than a Tier 3 drug with Aetna. Some retail pharmacies say they will charge the lower of the co-payment or the retail cost of the drug.
Another consideration is the dosage. Some companies will pay for 10 milligrams, but not for the 30 milligram dosage. If an individual needs the 30 milligram dosage, the entire cost of the drug will be the responsibility of the individual.
Some companies will require the doctor to prescribe medications through a process called "step therapy". "Step therapy" requires the individual to take "the least expensive drug" to see if the outcomes are satisfactory. If the outcomes are not satisfactory, the doctor can prescribe a more expensive drug (usually with higher co-pays), justifying medical necessity.
Prescription drug plans have contracts with "preferred" and "non-preferred" pharmacies. Individuals will pay a lower co-payment with a "preferred" than with a "non-preferred" pharmacy.
At the same time, Medicare beneficiaries will need to consider the out -of-pocket costs for premiums, deductibles, co-payments, and co-insurance. An analysis of the some of the plans shows that paying the lower premium, deductible, and co-payments may result in lower overall costs, than paying a higher premium with no deductible.
For assistance in analyzing the formularies, costs, prior authorizations, quantity limits, and the other restrictions, the health plan finder at www.medicare.gov is the tool to use to make comparisons. The Colorado Division of Insurance has a "hard copy" comparison of the plans of the most 200 commonly used drugs by seniors. Individuals can call 1-800-MEDICARE to get counseling and assistance with comparisons. To talk with a counselor in your area, or to make an appointment, call 1-800-503-5190.
For more information with selection of a plan, or enrollment assistance, call 303-333-3482.