Countdown to MMA: Timeline to implementation

July 11, 2005

On Jan. 1, 2006, Medicare Part D will begin. MMA provides for access to the prescription drug benefit through one of four options: a stand-alone prescription drug plan (PDP); a component of a Medicare Advantage (MA) managed care plan; an employer-sponsored qualifying plan; or a government-supported fallback plan in areas with only one private option. There are a number of key dates along the path to implementation.

Editor's note: Whenever the subject of the Medicare Modernization Act (MMA) comes up, invariably you'll hear that many questions still remain as to how the drug benefit will work. To clear up the confusion surrounding this fast-approaching law, Drug Topics is launching this monthly column as a survival kit for pharmacists. Please send an e-mail to drugtopics.@advanstar.com to let us know what you think of this column and the questions you would like our columnist to address.

On Jan. 1, 2006, Medicare Part D will begin. MMA provides for access to the prescription drug benefit through one of four options: a stand-alone prescription drug plan (PDP); a component of a Medicare Advantage (MA) managed care plan; an employer-sponsored qualifying plan; or a government-supported fallback plan in areas with only one private option. There are a number of key dates along the path to implementation.

A few important deadlines have already come and gone. Here are the remaining dates to watch for.

Patients who delay their plan selection until after Jan. 1 will cover their prescription costs as they did before the benefit became available. The one exception is those who receive a prescription benefit under Medicaid. Federal matching funds for these dual eligibles will not be available to Medicaid after Jan. 1. To avoid a gap in coverage, CMS will assign dual eligibles to a PDP in the fall and allow the beneficiary to switch plans if the assignment is not their preferred choice.

As of July 1, states began to accept applications from those with incomes up to 150% of poverty who are not already receiving a subsidy. Persons with low income can receive assistance through premium subsidies, a reduction in the annual deductible, a reduction or waiver of copayments, and continuous coverage beyond the $2,250 initial limit.

CMS will provide information to beneficiaries beginning in mid-2005 and send complete information to every beneficiary in September through the publication Medicare and You. The Social Security Administration (SSA) will work with CMS to get the word out. Early this summer SSA will send notice about Part D and information to low-income persons about how to apply for plan subsidies. State Health Insurance Assistance Programs (SHIP) and other local agencies have been enlisted to get information to all those eligible for the benefit.

By mid-October, an Internet-based tool for comparing PDPs will be available on the CMS Web site, http://www.medicare.gov/. The same comparative information will be available through a toll-free customer service line, 1-800 MEDICARE. However, the Advisory Panel on Medicare Education, made up of insurers, healthcare providers, and policy analysts, has warned CMS that additional initiatives certainly will be needed in order to reach elders and others eligible for Medicare.

One nongovernment organization working with CMS in outreach is Medicare Today, a group organized by the Healthcare Leadership Council from nearly 100 organizations representing seniors, patients, healthcare professionals, and employers. Medicare Today will produce written, audio, and video materials for distribution through the media and will hold town hall meetings in libraries and community centers throughout the country. A description of their activities, along with a list of key dates, can be found at http://www.medicaretoday.org/. E-mail bulletins can be requested at the same Web site.

Another helpful resource is the Access to Benefits Coalition, a collaboration of more than 90 patient, consumer, and senior advocacy and support organizations. More information about it can be found at http://www.accesstobenefits.org/. In addition to organizations set up specifically in support of Medicare, other advocacy organizations, including AARP and Area Agencies on Aging, are gearing up for outreach campaigns.