Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Deirdre Duzor Director, Pharmacy Division Centers for Medicare & Medicaid Services.

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Presentation transcript:

Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Deirdre Duzor Director, Pharmacy Division Centers for Medicare & Medicaid Services April 26/27, 2005

Purpose of this presentation Describe Medicaid wrap-around option Describe State Pharmaceutical Assistance Program (SPAP) wrap- around options

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

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

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

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)

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

SPAP Options – Part D (continued) Combination  Example, pay basic premium and cost sharing

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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