CMS has published the PDP Landscape files for 2001. If you haven’t seen these before it’s worth your while to take a look now. Here’s why.
Medicare beneficiaries that also qualify for Medicare (dual eligibles) are automatically assigned a Part D plan under most circumstances. CMS can assign them to a Medicare Advantage plan if they are currently enrolled in a Medicaid managed care plan. Most duals, however, do get assigned to a Part D plan.
Take a look at the landscape file and look for column E. Note the header information: “0$ Premium with Full Low-income Subsidy”. Plans that are eligible for beneficiary auto assignment will have an “x” in that box.
Don’t worry, I have done the work for you on this. Check out my chart. The spreadsheet shows the 34 regions by tab and lists the plans that were available for auto assignment in 2000. The next section shows the auto assignment plans for 2021.
Take a look at these to see which plans that are currently accepting auto assignments will no longer be eligible in 2021.
Suppose you have several residents enrolled in a particular Part D LIS subsidy plan. Suppose further that this plan will not be available for 2021. CMS policy in these cases is to assign the beneficiary to an eligible plan offered by the same sponsor as the one in which the beneficiary is currently enrolled. For example, if the beneficiary is currently enrolled in “Sample Medicare Drug Plan A” and the new list includes only “Sample Medicare Drug Plan B”, both of which are sponsored by the “Sample Medicare Drug Benefit” sponsor, the beneficiary will be assigned to Plan B.
Using this information you will have an idea of what to expect in terms of plan enrollment prior to January, when the new coverage becomes effective.
You may have taken the time and effort early in the year to arrange for beneficiaries to get access to non-formulary drugs. When the beneficiary is assigned to a different plan the process begins again.
Fortunately, CMS provides direction to the Part D plans on how they much handle access to non-formulary drugs for LTC residents. The direction is found in Chapter 6 of the Medicare Prescription Drug Benefit Manual. Beneficiaries are entitled to a minimum of 98 days supply of non-formulary drugs. Knowing this in advance will help the pharmacy and the facility create a plan to obtain plan authorization before the transition ends.
Ever try to find a directory of LTC pharmacies on the Internet? Pretty tough to do until now. Your next potential customer is now able to locate you and your competitors by conducting a simple search in our directory.
To make it more likely that they will contact you, please take the time to claim your listing. If your pharmacy isn’t on the list, take the time to add it.