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U.S. House and Senate Notification
Wednesday, December 27, 2006
| To: | Senate Finance Committee House Ways and Means Committee House Energy and Commerce Committee House and Senate Appropriations Committees House and Senate Budget Committees Other Interested Hill Staff |
| From: | Don Johnson Acting Director Office of Legislation Centers for Medicare & Medicaid Services |
| Re: | 2007 Medicare Part D Point-of-Sale Information |
To provide seamless drug coverage for Medicare and Medicaid dual eligible beneficiaries in 2007, CMS will continue to contract with WellPoint to provide the Point of Sale Facilitated Enrollment (POS FE) service.
In order to identify Medicare and Medicaid dual eligible beneficiaries, States submit monthly files of current full benefit dual eligibles and Medicaid beneficiaries approaching dual eligibility to CMS. CMS uses this data to assign these beneficiaries into Part D plans. However, the timing of these data exchanges can result in a gap in the transition of these beneficiaries from Medicaid drug coverage to Part D. To address transition gaps for dual eligibles in 2006, CMS contracted with the Part D sponsor Wellpoint to provide a point-of-sale facilitated enrollment (POS FE) service. Under this contract, WellPoint pays claims for any individual that pharmacies submitted to the POS FE system as confirmed dual eligibles without Part D enrollment, and then WellPoint coordinates with CMS. This process has succeeded in providing drug coverage to thousands of un-enrolled dual eligibles during 2006. For 2007, CMS has again contracted with WellPoint to provide the national POS FE service to dual eligibles who present at the pharmacy in need of medications before they are enrolled into a Part D plan. WellPoint will continue to immediately cover these beneficiaries.
It’s important to note that CMS anticipates that far fewer beneficiaries will need to use the POS enrollment option in 2007. Two reasons account for this: (1) the vast majority of dual eligible individuals are already enrolled in a Part D plan, including many of those current Medicare beneficiaries who become newly Medicaid eligible; and (2) for current Medicaid recipients who are about to become Medicare eligible, CMS and the States have implemented processes to identify these beneficiaries in advance and get them enrolled in a Part D plan as of the effective date of their dual eligibility.
Please find the following attached documents
- Information for State Policymakers: For more information on the point of sale facilitated enrollment services, CMS has developed the third document in the "Information for State Policymakers" series. This documents is also available at: http://www.cms.hhs.gov/States/Downloads/backgrounder_3final.pdf
- Information for Pharmacists: "POS Facilitated Enrollment Process in 4 Steps," provides information for pharmacists. This documents is also available at: http://www.cms.hhs.gov/States/Downloads/pos4steps.pdf
- Information for Beneficiaries: "Using Your Medicare Drug Coverage in 2007" explains what beneficiaries who joined a Medicare drug plan for the first time, or have switched to a new Medicare drug plan during the 2007 open enrollment should do to make sure their first visit to the pharmacy in 2007 goes smoothly. This documents is also available at http://www.cms.hhs.gov/States/Downloads/2007pharmacyvisit.pdf
Please contact Jennifer Snow (jennifer.snow@cms.hhs.gov or 202-690-5520) in the CMS Office of Legislation with any questions.