Medicare Part D

APA News Release on CMS proposed changes

NEW  Read APA's March 7, 2014 comments urging CMS not to remove antidepressants and antipsychotics from protected coverage status as part of the "six protected classes of clnical concern."

CMS released the Proposed Rule for Comment "Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs," which would remove antidepressants in 2014, with antipsychoatics under consideration for removal in 2015,  from the current list of drugs within "six protected classes of clinical concern."  [Published in the Federal Register, January 10, 2014]

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This federal outpatient prescription drug benefit, which began in 2006, applies to all Medicare beneficiaries, including those who are dually eligible for both Medicare and Medicaid.   The benefit is administered through private prescription drug plans (PDPs) that meet Medicare guidelines for the program.  People with Medicare select which of the plans being offered in their region best meets their needs.  

Financial assistance is available to people with limited incomes. Dual eligible beneficiaries will pay no premiums as long as they stay with a low-premium plan, but are still required to pay co-pays.  Other low-income people may apply for a low income subsidy through an application at their local Social Security Office (or online) or state Medical Assistance Office. 

Almost all beneficiaries, including dual eligibles, will have some form of co-pay for each prescription.  The co-pays will vary by plan.  Pharmacies are permitted to waive the co-pay but, unlike under Medicaid, are not required to do so if an individual is unable to pay.

For complete information about the Medicare Part D Prescription Drug Plan, visit the official Medicare.gov website to find out how to get drug coverage.

Additional Resources

 

 

KFF Issue Brief: “Medicare Part D Spending Trends: Understanding Key Drivers and the Role of Competition”