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Medicare Part D – Prescription Drug Coverage

This ACP website will assist you in helping your patients by providing you and your staff with basic, practical information on the Part D benefit and linking you to patient-oriented materials that you can use in your offices.

• Change in the Medicare Prescription Drug Program as a Result of the Healthcare Reform Legislation

• Information on Medicare Part D E-prescribing Incentive

• CMS releases an instructional guide on reimbursement for vaccine and vaccine administration under Medicare Part D

• Medicare Part D Short Course 2010

  This brief article lists the things every practitioner should know about the Medicare Part D Drug benefit.

• CMS Medicare Part D Information

• Exceptions and Appeals Process under Medicare Part D Drug Benefit

  All Part D plans are required to have an exceptions and appeals process that provides enrollees with the opportunity to challenge the exclusion of a particular drug from a plan's formulary or the placement of a drug on a higher cost-sharing tier. This ACP article reviews the basic requirements for exceptions and appeal procedures instituted by the different drug plans.

• Standardized Medicare Part D Coverage Determination Request Form

  The form can be used to request approval for a drug not in a plan’s formulary, for an exception to a formulary tier, and for providing data to meet prior authorization requirements.

Other Useful Educational Links

• Consumer Reports Best Buy Drugs—The information on this website can help patients learn about affordable drug treatment options to discuss with their physicians. More specifically, the site provides an expert medical review of those drugs commonly used to treat a variety of specific conditions or illness combined with the price of the drugs. The reports, which can be downloaded, also provide recommendations regarding the most cost effective treatments under different situations. The information on the Consumer Reports Best Buy Drugs link has been compiled as a free public educational service by the nonprofit Consumers Union.

• My Medicare Matters is a site sponsored by the National Council of Aging and the Access Benefit Coalition that provides useful information regarding the Part D Drug benefit delivered in three separate portals; one for beneficiaries, one for family and friends, and one for health care professionals.

Can't find what you need? Contact the CPII.

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Page updated: 1-26-12

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