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Memo - Vaccine
Access
Payment Options
Memo -
Incorrect Copays for Duals
180 Day
Q&A Institutionized Status
McClellan Remarks
Standardized Additional Messages
Press
Release on Messaging
Formulary Guidance
Roadmap
Transition
Appeals
Prescription Niacin
CMS Expectations
Final
CY 2007 Formulary
Formulary Guidance 2007
Enrollment Reconciliation Process
Q&A on Sales
Tax
Home
Infusion
HPMS
Transition
Medicare Part D Appeals and Exceptions Contacts
Standard Pharmacy
Notice for beneficiaries on coverage issues
LTC Coding Letter to
PDPs
Transition
Period Extended
Part D Drugs and Part D Excluded Drugs
Secretary Levitt's One Month Progress Report
POS Enrollment Update and
Member ID Field New Edit
Long Term Care - Part
B vs. D Letter
Niacin Notice
Regarding Payment of Related Claims
Per Se Eligibility Processing Overview
CMS Provider Letter
Medicare
Part B and Part D Drug Coverage Chart
Tip Sheet
for Pharmacies to provide to Patients
Wellpoint
- Four Step Process
Recent Letters to Plans -
Expedited Process for Low Income Beneficiaries
Strengthening Implementation of Formulary Transition
Information
from Pennsylvania Dept. of Public
Welfare and Medicaid – Five Day Supply
Governor's Press Release - 5 day Emergency Supply
CMS - Partner Letter
Governor
Rendell's Press Release
Medicaid
Covering Dual Left in "limbo"
Eligibility Tips
Providing transitional 14 day supply
CMS Pharmacists Help Letter
Reminder letter to Plans
Dual
-Eligibles - one page update
Dual Eligible Transition Paper
CMS
Scenarios - What if? Regarding the processing of
dual eligbles
From APhA - Q &
A
Information
will be regularly added to this website. Plan to check
it regularly!
PPA has been emailing and faxing our members regular updates
throughout 2005 in preparation and will continue to do so as
we go forward in 2006
Have your missed any of our frequent email/fax bulletins? -
review back copies here!
What every pharmacist should know -
Six Key Steps to Learning
1) Pharmacists
need to focus on learning as much as possible about the
Benefit. Here are some resources:
:: View Dr. Richard Stefanacci's PowerPoint
presentation as presented to PPA
during the annual meeting.
:: Go to CMS
website with
Information for Providers. read the articles
in the Drug
Coverage Series. They are relatively short - 2 to 3
pages.
:: Visit the CMS
specific section for
Pharmacists
::
PPA has
developed a list of key terminology to help you
understand the benefit. We also
have a
separate definition list
from Dr, Stefanacci, which you may want to also peruse.
:: PPA has added an
additional list of more key definitions and CMS has a
list of
preferred terminology to use in talking with potential
beneficiaries.
:: PPA has a list of continuing education
courses so you can
earn CE while learning about the
benefit.
:: Bookmark key websites.
So you can check for additional information frequently.
:: Consider participating in CMS
Open Forums to hear from and ask questions of CMS
leadership on topics of interest to your particular provider
type; for information about these
forums visit
http://new.cms.hhs.gov/OpenDoorForums/
:: Sign-up to receive
email notification of new information for pharmacies and
pharmacists
about the Medicare Modernization Act and Medicare
Prescription Drug Coverage.
Click here for access and to sign up for the
Pharmacy list.
2) Specifically
understand the low income benefit and promote it to seniors
who may qualify. Seniors who may qualify for this need to
apply NOW!
:: For
Information on this benefit,
click here
:: PPA has a
copy of a Social Security Administration
(SSA) flyer in both
English and Spanish
you can have available at your pharmacy.
:: PPA has
copies of the notices that were mailed in May 2005 to
qualifying seniors.
Pharmacists need to know what has been already sent out.
--
Notice for
Dual Eligibles
--
Notice for those in a Medicare Savings Program
--
Notice to
those who receive supplemental SSI income
--
A copy of
the actual application – you may want to have these
available
3) Read
and understand the contracts being offered by the PDPs. You have the choice to participate in the
contracts offered you - review them carefully.
Previously
PPA had published a list of various contracts and their
terms provided by PAAS National - however, Argus has
declared their contract information as proprietary and has
placed a cease and desist order. Therefore PPA has
elected to remove this information from our website.
We apologize that we are unable to provide this helpful
information to our pharmacists. However, we continue
to urge you to read specific contracts with great care.
4)
Determine to
what extent your pharmacy might be ready and interested in
providing Medication Therapy Management Services (MTMS).
::
APhA and NACDS
Core Elements of MTMS Document
5) Work
with your senior patients to promote plans that will work
for both them and your pharmacy.
::
Plan Finder Tool - help beneficiaries list their drugs
and search for
appropriate plans.
::
Medicare and You 2006 - An online version of the
handbook mailed all beneficiaries.
:: Overall
Fact Sheet for Beneficiaries
:: Low Income Application
(provided with the notices mailed out - per section 2
above)
::
Outreach
Toolkit on Medicare Prescription Coverage
An outreach kit designed to equip community level
organizations including pharmacists
with the materials needed to provide clear, accurate information and
assistance.
:: Promotional Opportunities -
Limited Income? SSA Can
Help - Posters to Display in
Health Care Settings: Limited-income Medicare
beneficiaries are directed to help with
prescription drug costs. Posters are suitable for display in
health care settings where
Medicare beneficiaries will see this information. To
order go to the Medlearn Product
Ordering
Page. You may also download and print flyer-size copies
of
the posters, using the PDF files, Poster 1 - Poster 4
:: Review the scripts being used by 1-800-MEDICARE.
These scripts are posted for your
reference and to understand what call center customer
service representatives are telling
beneficiaries. As the scripts are modified, updates will be
posted to this website. You
can find the scripts at
the
CMS website.
6)
Get your NPI as an individual
pharmacist
CMS is pleased to announce the availability
of a new identifier for use in the standard
electronic health care transactions. The National Provider
Identifier (NPI) will be the single
provider identifier, replacing the different provider
identifiers currently in use for each
health plan with which they do business. Obtaining the NPI
is
required in the
Health
Insurance Portability and Accountability Act of 1996 (HIPAA)
and will be the single national
provider identifier for pharmacists, pharmacies, and
prescribers no later than May 23,
2007.
National standards for electronic health care transactions
encourage electronic
commerce in the health care industry and simplify the
processes involved to reduce the
administrative burdens on health care providers. A May 6th
letter (linked below) was
distributed to aid in understanding the background of this
requirement & what steps are
necessary to apply for and receive your NPI.
http://www.cms.hhs.gov/hipaa/hipaa2/npi_provider.asp
Obtaining your NPI is recommended for individual pharmacists
now. Pharmacies may wish
to hold off on this process. For more Information on
the NPI, click here.
Your
Feedback needed!
Tell us what else you need to know about Medicare.
Send your questions to
ppa@papharmacists.com
and mark Medicare ? in the subject line.
We will work on establishing a Frequently Asked Questions
(FAQ) section next.
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