Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Deirdre Duzor Director, Pharm

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Medicare Prescription Drug, Improvement, and
Modernization Act of 2003Deirdre
DuzorDirector, Pharmacy DivisionCenters for
Medicare Medicaid ServicesApril 26/27, 2005
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Purpose of this presentation

• Describe Medicaid wrap-around option
• Describe State Pharmaceutical Assistance Program
  (SPAP) wrap-around options

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Medicaid Wrap-around

• Federal Financial Participation is available only
  for drugs not covered by Part D and currently
  covered at state option (1927(d)(2) drugs)
• Smoking cessation drugs, while in 1927(d)(2), are
  covered under Part D

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Medicaid Wrap-around (continued)

• States will receive FFP for these drugs
• Two types of drugs on this list benzodiazepines
  and barbiturates present transition issues
• CMS hopes state will cover, at least for awhile
• If states cover 1927(d)(2) drugs for dual
  eligibles, they must also cover for moms and kids
  because of Medicaid comparability requirements

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Dual Eligible Transition

• PDPs must have a transition plan approved by CMS
• State Medicaid agencies may also assist by
  providing up to a 90day supply of maintenance
  drugs

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SPAP Wrap-around

• Under Part D, a State Pharmaceutical Assistance
  Program (SPAP) is a state program that provides
  financial assistance for supplemental
  prescription drug coverage for Part D eligible
  individuals
• Provides assistance to such individuals in all
  Part D plans (does not discriminate based on the
  Part D plan in which the individual is enrolled)

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SPAP Options Part D

• Contribute toward cost sharing that will count
  toward the True Out of Pocket costs (TrOOP)
• Secondary payer on claims
• Lump sum payment to PDP
• Pay premiums
• Basic
• Supplemental

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SPAP Options Part D (continued)

• Combination
• Example, pay basic premium and cost sharing

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SPAP Role in Outreach and Education

• SPAPs are important partners with the Federal
  government in reaching out to and educating SPAP
  enrollees about Part D
• MMA provides 62.5 million in grants to SPAPs for
  each of FFY 2006 and 2006
• Applications approved for 21 states
• Per capita grant approximately 100 (over 2
  years)

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Questions/Comments?