Beginning January 1, 2006, nursing home residents, including all those dually-eligible for Medicare and Medicaid (the dual-eligibles) and many Medicare-only residents will enroll in the new drug benefit (also known as Part D). The benefit will be administered by private health plans, managed care organizations, and pharmacy benefit managers (PBMs) acting as prescription drug sponsors. There will be enrollees in different drug plans within the same nursing home.

The Centers for Medicare and Medicaid Services (CMS), and other government agencies (like the Social Security Administration and state Medicaid offices) are very active on several fronts in preparation for the January 1st launch of the new benefit. These agencies will be undertaking several key actions, including:

• The SSA and state Medicaid programs have identified beneficiaries who may be eligible for reduced or no cost-sharing due to low-income or disability,
• CMS has reviewed drug plans and related marketing materials,
• All three agencies are conducting outreach and beneficiary education, and
• SSA and state Medicaid offices will be automatically enrolling the dual-eligibles (randomly assigning people to plans) and facilitating the enrollment of other subsidy-eligible individuals into plans.

CMS and other agencies may approach you in their outreach and identification efforts. KPS Pharmacy also will be monitoring these activities and will provide you with details about these agency activities and help you link up with agency resources. You may be asked by patients and their families to explain the Medicare Part D benefit, the particular plans offered to your residents, and other enrollment issues. KPS Pharmacy has created a brochure to explain the Part D Drug benefit to residents and their families. Please click here to open a PDF of the brochure.

Q: Can those people with Medicaid coverage stay in Medicaid?

People who are Medicaid-only will continue to receive drug coverage through Medicaid; those individuals who are dually-eligible for Medicare and Medicaid must enroll in a Part D plan for coverage beginning January 1, 2006.

Q: When will the auto-enrollment of the dual-eligibles begin?

The SSA and state Medicaid offices are in the process of identifying the dual-eligibles and informing them of their change in benefits. Automatic enrollment for dual-eligible beneficiaries has begun and becomes effective January 1, 2006. During November and December, dual eligibles residing in nursing homes will have the opportunity to choose their own Part D plan in lieu of being automatically enrolled, although some plan choices would require the enrollee to pay a premium.

Q: How will we manage patients enrolled in different Part D plans?

KPS Pharmacy will help you manage the drug regimens of your patients, even if they are in different plans. It is possible for beneficiaries in the nursing home to switch from one plan to another, at any time during their stay. Patients may choose to switch plans if their current plan does not have KPS Pharmacy in its network, or if they are not in optimal plans. Nursing homes may help a patient switch plans. Please click here to see a list of KPS Contracted PDPs.