Medicare Part D

As part of President Bush’s Medicare Modernization Act, prescription drug coverage are provided by Medicare beginning January 1, 2006. This program, called Medicare Part D, impacts certain individuals who are currently insured by Medicare and receiving services within the DMHAS system. The new program significantly changed prescription drug coverage for dually insured individuals (individuals eligible for Medicare and Medicaid) who previously received prescription coverage through Medicaid. It also offers a new benefit for all other Medicare recipients. The information related to Medicare Part D is provided in an effort familiarize providers and consumers with these changes and the Medicare implementation timeline. The site will be updated as additional information becomes available. 

• Medicare and You Handbook 2006
• Tip Sheet for Selecting a Part D Plan
• Part D and CONNPACE, a Fact Sheet
• Part D and People with Medicaid and Medicaid Spend Down, a fact sheet
• Medicare Part D Update #1
• Download Medicare Part D Training Revised Sept. 2005
• Medicare Formulary Requirements
• Low Income Subsidy (LIS)
• Medicare Notification Letters:
  • Deemed Letter (english)
  • Deemed Letter (spanish)
  • Medicare SSI letter (english)
  • Medicare SSI letter (spanish)
  • Medicare SSI-MSP

Helpful Links:

• Medicare  1-800-MEDICARE (1-800-633-4227)

• Centers for Medicare and Medicaid Services (CMS)/Medicare Part D Info

• Center for Medicare Advocacy, Inc.

• Social Security Administration  

• Medicare Part D-Explanation of State and Federal Assistance for Program Beneficiaries

• Centers for Medicare and Medicaid Services (CMS) Part D Program Analysis

• National Council for Community Behavioral Health Care Medicare Resources

Low-Income Subsidy (LIS)

The National Alliance on Mental Illness of Connecticut (NAMI-CT) is holding presentations and staffing informational tables to raise awareness in the mental health community of the Low-Income Subsidy (LIS) available to some Medicare Part D beneficiaries who meet income and resources limits.   NAMI-CT is eager to come out to clubhouses, provider and other interested groups to present and distribute information about the LIS and how to apply.  The LIS pays for 75% or more of prescription drug costs and in 2009 is estimated to be worth $3,923 at the pharmacy and as much as $298 in annual premiums.  DSS estimates that there are 13,000 CT residents who don't know that they are eligible for the LIS! 

To find out when and where presentations and informational tables are currently scheduled, or to request a presentation or table for your group, or to have flyers and applications mailed to you, please contact Amy O’Connor at (800) 215.3021 or at policyassistant@namict.org.” 

• Low Income Subsidy Flyer
• Low Income Subsidy - Questions & Answers  

Medicare Part D UPDATE #1  (June 22, 2005)

Coverage for Antipsychotic, Antidepressant, and Anticonvulsant Medications

On June 10, 2005 CMS advised all bidders for the Prescription Drug Plan that they must cover “all or substantially all” of the approved medications in the following categories:

Antipsychotic, antidepressant, anticonvulsant, anticancer, immunosuppressant, and HIV/AIDS.

This means that these medications must be included in the formularies of any Part D Prescription Drug Plan. This new requirement addresses a number of concerns relating to the availability of front line medications for our clients.

Coverage for Barbituates and benzodiazepines

Recent CT legislation states DSS is responsible for covering “non Medicare covered drugs”. This means that DSS will cover barbiturates and benzodiazepines for persons with dual eligibility (Medicare/Medicaid) as these drugs are “non Medicare covered drugs”. The protocol for obtaining Medicaid coverage is not clear but this means that DMHAS clients who require barbiturates or benzodiazepines will be able to continue that treatment regimen.   

CT Legislative Session and Medicare Part D

The Connecticut Legislative Session recently concluded. Legislation regarding Medicare Part D was enacted but the legislation eliminated provisions for wraparound coverage. The legislature did not provide any wraparound benefits for co-payments for dually eligible individuals. Unless this is addressed in the upcoming Special Session, dually eligible clients will be responsible for co-pays of $1.00 to $3.00 per prescription. The legislation did assign responsibility to DSS to cover non-Medicare covered prescriptions. However the definition of “covered drugs” is quite broad and will most likely provide minimal assistance to individuals within our system except as it relates to barbiturates and benzodiazepines. This is less of an issue because of the new requirements for Prescription Drug Plans detailed under the first heading above.

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