Transcript 0504MMADuzor (Medicare Prescription Drug, Improvement, and

Medicare Prescription Drug,
Improvement, and Modernization
Act of 2003
Deirdre Duzor
Director, Pharmacy Division
Centers for Medicare & Medicaid Services
April 26/27, 2005
Purpose of this presentation
• Describe Medicaid wrap-around
option
• Describe State Pharmaceutical
Assistance Program (SPAP) wraparound options
Medicaid Wrap-around
Federal Financial Participation is available
only for drugs not covered by Part D and
currently covered at state option
(1927(d)(2) drugs)
Smoking cessation drugs, while in
1927(d)(2), are covered under Part D
Medicaid Wrap-around (continued)
 States will receive FFP for these drugs
 Two types of drugs on this list –
benzodiazepines and barbiturates – present
transition issues
 CMS hopes state will cover, at least for awhile
 If states cover 1927(d)(2) drugs for dual
eligibles, they must also cover for moms and
kids because of Medicaid comparability
requirements
Dual Eligible Transition
PDPs must have a transition plan
approved by CMS
State Medicaid agencies may also assist
by providing up to a 90–day supply of
maintenance drugs
SPAP Wrap-around
Under Part D, a State Pharmaceutical
Assistance Program (SPAP) is a state
program that provides financial assistance
for supplemental prescription drug
coverage for Part D eligible individuals
Provides assistance to such individuals in
all Part D plans (does not discriminate
based on the Part D plan in which the
individual is enrolled)
SPAP Options – Part D
Contribute toward cost sharing that will
count toward the True Out of Pocket costs
(TrOOP)
Secondary payer on claims
Lump sum payment to PDP
Pay premiums
Basic
Supplemental
SPAP Options – Part D (continued)
Combination
Example, pay basic premium and cost
sharing
SPAP Role in Outreach and Education
SPAPs are important partners with the
Federal government in reaching out to and
educating SPAP enrollees about Part D
MMA provides $62.5 million in grants to
SPAPs for each of FFY 2006 and 2006
Applications approved for 21 states
Per capita grant approximately $100 (over
2 years)
Questions/Comments?