Part D Transition Requirements Issued for 2011

Medicare Part D Plans have received requirements from the Centers for Medicare and Medicaid Services on transition requirements for beneficiaries.

 

In a handout developed for advocates who help clients with Part D transition issues, NSCLC has set out the Centers for Medicare and Medicaid Services (CMS) minimum requirements for all Medicare Part D prescription drug plans for 2011.

In short, CMS requires that sponsors of Part D plans provide beneficiaries with access to transition supplies—usually a 30 day fill--of needed medications to protect them from disruption when they change to a plan that does not cover the drug and in other limited circumstances.  The transition supply is meant to give beneficiaries adequate time to a) change to a drug that is on a plan’s formulary, b) file a formulary exception request, or c) enroll in a different plan (particularly important for Low Income Subsidy (LIS) recipients).   

In early 2011, transition rules will be especially important for low income beneficiaries who were automatically reassigned to new plans, which may or may not cover their medications.

In addition, all plans change their formularies each year, so even people who remain in the same plan may find that their plan no longer covers their medications or has newly imposed utilization management requirements.

To download the handout, click here.