January 2007 Vol. 26. No. 1

Published by the Humboldt Senior Resource Center in Eureka, California. HSRC is a non-profit community-based organization offering services for senior citizens, multi-generational families and caregivers.

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Medicare drug plans for January

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If you have a Medicare drug plan, here are five things you need to know for January 2007.

1. Have Your ID Numbers

If you enrolled in a new plan by Dec. 8, you should have received a welcome packet from your drug plan by Jan. 1. The packet should include information on the plan including the plan formulary (drugs the plan covers) and your drug plan ID card. If you need to use your prescription benefit in early January and have not received an ID card you need to call the plan and ask for the following four numbers for your pharmacy to be able to bill the plan:

• Your Plan ID
• Rx Bin
• Rx Group
• PCN


2. You have the right to a 30-day fill

If you changed your drug plan for 2007, the plan is required to provide 30 days transitional supply (also called temporary fill) of any medication you are taking. This 30-day fill must be provided even if the medication is not on the plan formulary. If the plan does not cover the drug, you will need to have your doctor file an exception by February.

Medicare also requires that the 30-day fill must be provided for any medications that require prior authorization or have a step-therapy requirement. By February you will need to have your doctor file the appropriate documents to your plan for prior authorization or step therapy or you can have the doctor file an exception.

3. Your plan may not cover the same drugs as in 2006

If you stayed in the same plan from 2005, the plan formulary may have changed. If your medication is no longer on the formulary you will need to have your doctor file an exception with the plan to get the medication covered.

4. You have the right to file an exception

If your plan does not cover your medication you can have your doctor ask the plan to cover the medication. This is called filing an exception. The doctor must file the exception with the plan and must use the plan's exception forms. The exception must explain the medical reason why you need the particular drug and cannot substitute a drug that the plan covers. If the doctor asks for a standard exception, the plan has 72 hours to make a decision; if the the doctor asks for an expedited exception, the plan has 24 hours to make a decision.

5. Where to go for help

If you need help obtaining your medications you can call HICAP for help. Call 444-3000 in Humboldt and 464-7876 in Del Norte. Or call toll free 800-434-0222