Review Patient Prescriptions Before Part D Enrollment

Now is the time to begin reminding your patients to review their Medicare-eligible medications to ensure their drugs are on the 2007 formularies of those patients' Part D prescription plans. That's because Part D plan enrollment begins Nov. 15, giving patients the chance to remain in their current Part D plans or, if necessary, change to coverage that better meets their needs.

In general, stand-alone and Medicare Advantage prescription plans will offer more of the most frequently prescribed drugs in their 2007 formularies than they did in 2006, according to "Medicare Part D 2007 Formulary Changes," (PDF file: 3 pages / 48.6 KB. More about PDFs.) a CMS tip sheet for physicians and patients.

Stand-alone plans will see "at least a 13 percent increase, on average, in the number of items … on formularies," says the tip sheet. In addition, there will be a "small decrease" in the number of drugs that require prior authorizations, but an increase in the number of drugs requiring step therapy and quantity limits. Medicare Advantage plans generally also will have an increase in the number of items included on formularies, but they will add more step therapy, prior authorization and quantity limit requirements in 2007, according to CMS.

In addition, the premiums for such plans may be rising in 2007. According to a Families USA analysis (PDF file: 12 pages / 536 KB. More about PDFs.) comparing 2006 plans with those to be introduced in 2007, monthly premiums for stand-alone plans that offer coverage for brand-name and generic drugs through the "doughnut hole" -- the gap in coverage when the patient pays 100 percent of his or her prescription costs -- will increase by between 21.8 percent and 185 percent. In 2007, beneficiaries will enter the doughnut hole when they reach $2,400 in covered costs and emerge from it when they reach $5,451 in expenditures -- a $201 increase over 2006 amounts, according to the analysis.

Prescription plans are required to offer a transition plan for patients who are taking drugs affected by formulary changes, CMS said in a Nov. 1 memorandum to Part D sponsors. The transition "is not simply to provide a temporary supply of nonformulary drugs for a specified period of time but, rather, to provide your enrollees with sufficient time to work with their health care providers to switch to a therapeutically appropriate formulary alternative or to request a formulary exception on the grounds of medical necessity," the memo says.

That means plans must choose between

Medicare beneficiaries who do not want to change their Part D plans don't need to do anything. Patients who want to change their plans must do so by Dec. 31; CMS officials urge patients to enroll by Dec. 8 to ensure continuity of prescription coverage.

Family physicians and their patients can find more information on Part D at Medicare's Web site and on the Medicare Rights Center Part D Web page. AAFP's Medicare Prescription Drug Coverage Web page provides physician-focused information, including forms to send Part D concerns to CMS, a standardized Exceptions Request Form and a Pharmacist-to-Physician Fax Form. Also available are links to the Medicare Prescription Drug Plan Finder.