GOOD TO KNOW: Medicare Part D beneficiaries will see a 50% savings on applicable drugs in the coverage gap in 2011

The Centers for Medicare & Medicaid Services (CMS) recently issued new guidance to Part D plan sponsors to guarantee that Medicare beneficiaries enrolled in Part D prescription drug plans will see 50 percent savings on their brand name and some authorized generic drugs when they enter the coverage gap, or donut hole, during 2011.

CMS also issued the draft model agreement that drug manufacturers of applicable Part D drugs will sign in order to participate in the discount program. Discounts will apply when the beneficiary reaches the coverage gap. Eligible beneficiaries will see the discount when they buy their drugs at their local pharmacy counter.

On June 1, CMS hosted a public meeting to discuss and collect public feedback about the draft manufacturer agreement, and to gather feedback about the final Part D guidance recently released. CMS encouraged drug manufacturers, Part D plan sponsors, and representatives from the beneficiary advocacy community to provide input and comments. All stockholders could register online at: http://cmsconference.hcmsllc. com/Conf06012010/register.aspx.

Closing the coverage gap is an important part of the Patient Protection and Affordable Care Act of 2010, (the Affordable Care Act) signed by President Barack Obama earlier this year, beginning with a one-time check for $250 in 2010 for those that reach the donut hole in 2010 and are not eligible for low-income assistance, the 50 percent discount for brand-name and some authorized generic drugs beginning in 2011 and additional savings until drugs are covered throughout the coverage gap by 2020.

If you have any additional questions, you may call Pat Hafermann, elderly benefits specialist with the Aging and Disability Resource Center, at (920) 467-4076.

Resource: “The Specialist” May 2010