Benefit Overview
Beginning in November, Medicare beneficiaries will be able to enroll in private plans that contract with Medicare to provide prescription drug coverage to begin January 1, 2006. These prescription drug plans (PDPs) will provide coverage for drugs only while beneficiaries will continue to get their other Medicare benefits through the fee-for-service program or Medicare Advantage plan as they had before.

In addition to the monthly Medicare Part B premium, beneficiaries who join a Medicare drug plan will pay a monthly premium that will range from $20 to $32, a $250 annual deductible, and coinsurance or co-payments for their covered drugs. These cost sharing thresholds will likely rise with the growth in per capita Medicare drug spending over the years.

By law, Medicare drug plans must cover at least two drugs in each therapeutic class or category of covered drugs, but CMS expects plans to provide access to a broad range of medically appropriate drugs. Drug plans can use tiered cost-sharing arrangements, prior authorization, and other cost management tools, as long as they do not discourage enrollment by eligible individuals.

Medicare will provide additional cost-sharing assistance to beneficiaries with limited incomes and resources. Specifically, Medicare beneficiaries who also qualify for Medicaid (dual eligibles) automatically qualify for this assistance. For more information on low-income assistance, please click here http://www.cms.hhs.gov/medicarereform/lir.asp.

Resources
RPA has joined other provider, patient, government, and industry representatives in an effort to increase awareness and understanding of Medicare Part D through the Kidney Medicare Drugs Awareness and Education Initiative. The initiative is an effort by the entire kidney community designed to provide timely, consistent, reliable, and up-to-date information about Medicare and Medicare Prescription Drug Coverage (Part D). With the objectives of increasing awareness of the new benefit, providing resources concerning Part D drug coverage for physicians and other providers, and ultimately helping people with kidney disease feel confident in their choice of drug plans, the community-wide buy in and participation will minimize duplicative and potentially conflicting information.