Pharmacies get help with Part D dual eligibles

January 23, 2006

Uncle Sam has come up with a way for pharmacists to fill prescriptions for Medicaid patients who were not automatically enrolled in Medicare Part D and sign them up for a drug plan.

Uncle Sam has come up with a way for pharmacists to fill prescriptions for Medicaid patients who were not automatically enrolled in Medicare Part D and sign them up for a drug plan.

Pharmacists are able to use the point-of-sale-facilitated enrollment process for patients eligible for both Medicare and Medicaid and fill their scripts at the subsidized co-pay amount before they leave the pharmacy. The system was created by the Centers for Medicare & Medicaid Services as a safety net for any of the estimated six million dual eligibles who fall through the bureaucratic cracks.

If a Medicaid patient shows up at the counter with an Rx but no Part D card, pharmacists can dispense the medication and bill a single preestablished account set up by WellPoint, the Indianapolis insurer hired by CMS to pay Rx claims for nonenrolled dual eligibles. The claim is paid and the pharmacist gives the medication to the patient at the $1 or $3 co-pay level.

The electronic system to help pharmacies cope with unenrolled dual eligibles was applauded by Roy Bussewitz, VP of telecommunications standards, National Association of Chain Drug Stores. Noting that CMS has been working closely with NACDS, he added, "They're trying to dot every i, and I'm very impressed. We do have an issue with reversing claims, but the tool is there to be used, and it will work."

The National Community Pharmacists Association "applauded" the dual-eligible solution created by CMS to smooth out some bumps on the path to Part D, said Carol Cooke, director of external communications. NCPA has also been working hand in glove with the agency on behalf of independent pharmacy owners.

"The bottom line for our members is to do what's best for their patients," said Cooke.