Tools
CMS Pharmaceutical, Pharmacy, & Device Manufacturers Open Door Forums
Technical assistance
Provides information on a series of CMS forums addressing pharmacy issues. Includes call-in instructions for the next call, how to register for the mailing list, and links to pharmacy-related fact sheets.
Help With Medicare Prescription Drug Costs: Information for Organizations
Web site
Resources for organizations to assist in providing information to Medicare beneficiaries about extra help available for people applying for Medicare Prescription Drug coverage.
Low Income Subsidy Outreach Toolkit
Web site
Toolkit for organizations interested in helping Medicare beneficiaries who qualify for the low income subsidy (LIS) to learn about and apply for extra help in paying for prescription drugs.
Medicare Health and Prescription Drug Plan Tracker
Web site
Interactive tool providing information about private plans participating in the Medicare Advantage program and the Medicare prescription drug program. Includes national statistics specific to rural areas.
Medicare Health Plans - General Information
Web site
Information for current and future contracting Medicare Advantage Organizations, other health plans, and other parties interested in the operational and regulatory aspects of the Medicare Advantage program.
Medicare Modernization Act
Web site
Information on CMS implementation of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Includes links to CMS fact sheets and press releases, as well as other resources for understanding the impact of the MMA.
Medicare Part D & Safety Net Providers: Contracting with Prescription Drug Plans
Web site
Information for safety net providers about the impact of the Medicare Prescription Drug Program. Addresses contracting with Prescription Drug Plans (PDPs) and includes a sample pharmacy contract addendum.
Medicare Part D Changes in Enrollment & Eligibility for Low Income Subsidy
Web site
Describes common situations facing safety net patients during the Medicare Part D open enrollment period that ends December 31, 2006 and ways that safety net providers can help.
Medicare Prescription Drug Coverage - General Information
Web site
Links to important information on the new Medicare prescription drug benefit. Includes prescription drug benefit pharmacy training information.
Medicare Prescription Drug Coverage Outreach Toolkit
Print publication
Designed to equip community-level organizations with the materials needed to provide information and assistance to their clients on the Medicare prescription drug coverage.
Medicare Prescription Drug Plan Finder
Web site
Online tool for identifying and enrolling in Medicare prescription drug plans. Includes information about plans available in each state. Available in Spanish.
Medicare Resource Kit
Web site
Links to technical information and press releases on the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Medicare RX: National Conversation-Friends and Family First
Web site
Aids faith-based and community organizations working with individuals eligible for the Medicare prescription drug benefit. Describes five steps to select a Medicare prescription drug plan.
Medicare.gov
Database
Searchable database on a host of Medicare related tools, including prescription drug plans, publications, and nursing home comparing.
MedlinePlus: Medicare Prescription Drug Plan
Web site
Links to resources, tools and news related to the Medicare prescription drug plan (Part D).
Prescription Drug Coverage Information for Partners
Web site
Outreach resource materials and information for organizations working to inform people about Medicare's new outpatient prescription drug coverage.
Rural Health Research: Medicare Part D
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of Medicare Part D, produced by the Office of Rural Health Policy's funded rural health research centers.
Using the Medicare Prescription Drug Plan Finder
Web site
Provides information for individuals about how to use the tools available to help make a decision about a Medicare prescription drug plan.
Regulations, Forms & Other Useful Documents
2008 Medicare Advantage (MA), Medicare Advantage-Prescription Drug (MA-PD), Cost-Based Plan, and Stand Alone Prescription Drug Plan (PDP) Call Letter
Sponsoring organization: Centers for Medicare & Medicaid Services
Provides information for health plans regarding how to implement CMS policies and procedures and comply with critical program requirements for the 2008 contract year. Includes detailed information on the Medicare Advantage (Part C) and prescription drug (Part D) programs.
Date: 04 / 2007
Bridging the Coverage Gap
Sponsoring organization: Centers for Medicare & Medicaid Services
Information for Medicare beneficiaries about the Medicare prescription drug program's coverage gap. Includes options to avoid or delay entering the gap and continue to save money on drug costs
while in the gap.
Date: 08 / 2006
Definition of Rural in the Context of MMA Access Standards for Prescription Drug Plans
Author(s): Keith J. Mueller, Rebecca T. Slifkin, Michael D. Shambaugh-Miller, Randy K. Randolph
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Describes how the definition of rural will impact rural access to prescription drug plans under the Medicare Prescription Drug, Improvement, and
Modernization Action of 2003 (MMA). A joint publication of the RUPRI Center for Rural Health Policy Analysis and the North Carolina Rural Health Research and Policy Analysis Center.
Date: 09 / 2004
Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Provides updated findings about Medicare beneficiary enrollment in prescription drug plans (PDPs) in rural and urban areas across the United
States. Updates findings presented in RUPRI Center Policy Brief PB2006-8.
Journal citation: RUPRI Rural Policy Brief Volume 12 Issue 1
Date: 01 / 2007
Estimates of Medicare Beneficiaries' Out-of-Pocket Drug Spending in 2006
Author(s): Jim Mays, Monica Brenner, Tricia Neuman, Juliette Cubanski, Gary Claxton
Sponsoring organization: Kaiser Family Foundation
Overview of how spending on prescription drugs is likely to vary among Medicare beneficiaries who are enrolling in Medicare Part D prescription plans in 2006.
Date: 11 / 2004
Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
The findings from this study, along with specific suggestions made by pharmacists during the interviews, suggest short-term actions that can be taken to address the challenges faced by rural independent pharmacies who are the sole providers in their communities. A joint publication of the North Carolina Rural Health Research & Policy Analysis Center and the RUPRI Center for Rural Health Policy Analysis.
Date: 11 / 2006
Facts About Medicare Prescription Drug Plans
Sponsoring organization: Centers for Medicare & Medicaid Services
Overview of the Medicare Prescription Drug benefit, with answers to common questions Medicare beneficiaries may have about the program.
Date: 10 / 2005
How the Coverage Gap Works for People with Medicare Prescription Drug Plans
Sponsoring organization: Centers for Medicare & Medicaid Services
Information for people helping those covered by Medicare describing the Medicare prescription drug program's coverage gap.
Date: 08 / 2006
Improving the Medicare Part D Program for the Most Vulnerable Beneficiaries
Author(s): Laura Summer, Patricia Nemore, Jeanne Finberg
Sponsoring organization: Commonwealth Fund
Discusses some of the challenges vulnerable Medicare beneficiaries face in using Part D and makes specific recommendations such as using simpler, more standard procedures and ensuring that needed counseling support is provided.
Date: 05 / 2007
Information for HRSA Grantees on Medicare and Pharmacy Services
Sponsoring organization: Office of Rural Health Policy
Includes key messages for HRSA Grantees, along with links and information about Medicare Part D reimbursement.
Date: 05 / 2006
Low-Income Assistance Under the Medicare Drug Benefit
Sponsoring organization: Kaiser Family Foundation
Provides an overview of the Medicare drug benefit and the additional subsidies available to certain eligible low-income beneficiaries.
Date: 07 / 2007
Medicare Advantage Fact Sheet
Sponsoring organization: Kaiser Family Foundation
Provides an overview of the Medicare Advantage (MA) program. Includes information on MA benefits, premiums, enrollment, and future issues.
Date: 03 / 2007
Medicare Drug Coverage under Medicare Part A, Part B, and Part D
Sponsoring organization: Centers for Medicare & Medicaid Services
Overview of drug coverage under Medicare Part A, Part B and Part D, with information on what drugs are covered under each part of the Medicare program.
Date: 08 / 2007
Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Early information on enrollment in the Medicare prescription drug program in rural and urban areas. Includes findings from an
analysis of plans available to rural persons under
Medicare's Part D program.
Date: 04 / 2006
Medicare Payment Basics: Part D Payment System
Sponsoring organization: Medicare Payment Advisory Commission
Overview of the Medicare Part D prescription drug benefit. Includes information on Medicare subsidies, Medicare payments to plans, and the calculation of enrollee premiums.
Date: 09 / 2006
Medicare Prescription Drug Benefit (Fact Sheet)
Sponsoring organization: Kaiser Family Foundation
Provides information and data about the Medicare Drug Benefit, including a breakdown of the standard benefit, updates on additional low-income assistance, and the latest 2006 enrollment data.
Date: 06 / 2007
One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report)
Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A findings brief is also available.
Date: 09 / 2007
One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief)
Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A final report is also available.
Date: 10 / 2007
Part D Reference Guide for Pharmacists
Sponsoring organization: Centers for Medicare & Medicaid Services
Comprehensive resource on Medicare Part D for pharmacists, which may also be useful to other providers and partners.
Date: 10 / 2006
Prescription Drug Spending and Coverage Among Rural Medicare Beneficiaries in 2003
Author(s): Craig Caplan, Normandy Brangan
Sponsoring organization: AARP Public Policy Institute
Examines out-of-pocket spending on prescription drugs by noninstitutionalized rural Medicare beneficiaries age 65 and older. Includes information on supplemental insurance coverage among rural and urban Medicare beneficiaries.
Date: 2004
Report to the Congress: Issues in a Modernized Medicare Program
Sponsoring organization: Medicare Payment Advisory Commission
Examines issues affecting the Medicare program. Addresses Part D, Medicare's new outpatient prescription drug benefit, with some coverage of rural issues. Includes overview of the Medicare Advantage program. Discusses the effects of the Critical Access Hospital (CAH) provisions in the MMA.
Date: 06 / 2005
Retail Pharmacy Participation in Medicare Part D Prescription Drug Plans in 2006
Author(s): Daniel R. Levinson
Sponsoring organization: U.S. Department of Health and Human Services
Office of Inspector General report discussing the extent to which retail pharmacies participate in
Medicare Part D stand-alone prescription drug plans (PDPs). Includes comparison of pharmacy participation rates among metropolitan and non-metropolitan pharmacies.
Date: 06 / 2007
Review of the Relationship between Medicare Part D Payments to Local, Community Pharmacies and the Pharmacies' Drug Acquisition Costs
Author(s): Office of Inspector General
Sponsoring organization: U.S. Department of Health and Human Services
Analyzes the relationship between Medicare Part D payments, excluding dispensing fees, to local, community pharmacies and the pharmacies’ drug acquisition costs. Estimate Part D dispensing fees and compares them with Medicaid dispensing fees. Includes some data specific to rural pharmacies.
Date: 01 / 2008
Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
Author(s): Curt Mueller, Keith Mueller, Janet Sutton
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Identifies sections of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) that might be of special concern to rural Medicare beneficiaries, medical care providers, and policymakers. Includes guidance regarding provisions in the Proposed Rule "Establishment of the Medicare Advantage Program," which implements Title II of the MMA, with a focus on its impact on rural health service delivery.
Date: 08 / 2004
Strong Competition and Beneficiary Choices Contribute to Medicare Drug Coverage with Lower Costs Than Predicted
Sponsoring organization: Centers for Medicare & Medicaid Services
Fact sheet providing information on Medicare Part D plan premiums for 2008, as well as an overview of the Medicare prescription drug program, the most recent Part D enrollment period, and outreach efforts for the low-income subsidy.
Date: 08 / 2007
Terms & Acronyms
Enrollment Period For Medicare Part D, those already on Medicare can enroll in the drug benefit between November 15 and December 31, and coverage would be effective on January 1 of the new year. If you were first eligible to enroll before May 15, 2006 but did not sign up, you may need to pay a late enrollment penalty.
Initial Enrollment Period For Medicare Part D, those already on Medicare could enroll in the drug benefit from Nov. 15, 2005 to May 15, 2006.
Medicare Advantage A type of Medicare plan offered by a private insurance company that contracts with Medicare to provide Medicare Part A and Part B benefits. Also called Part C or Medicare + Choice, Medicare Advantage Plans are HMOs, PPOs, Private Fee-for-Service Plans, or Medicare Medical Savings Account Plans. For beneficiaries enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan, and are not paid for under the Original Medicare Plan.
Medicare Advantage Prescription Drug Plan (MA-PD) Medicare Advantage Plans that offer prescription drug coverage in additional to Medicare Part A and Part B benefits.
Medicare Part D Prescription drug benefit added to Medicare in 2006. Created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Medicare Prescription Drug Plan (PDP) A Medicare program that provides prescription drug coverage as a supplement to traditional fee-for-service Medicare. The stand-alone drug plans are offered by insurers and other private companies to beneficiaries enrolled in Original Medicare.
Medigap A Medicare supplement insurance policy sold by private insurance companies to fill gaps in Original Medicare Plan coverage.
True Out-of-Pocket Costs (TrOOP) Drug costs paid by a Medicare enrollee, or on behalf of an enrollee by a family member, charitable organization, or State Pharmacy Assistance Program.
