Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Deirdre Duzor Director, Pharm - PowerPoint PPT Presentation

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Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Deirdre Duzor Director, Pharm

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Describe State Pharmaceutical Assistance Program (SPAP) wrap-around options ... Under Part D, a State Pharmaceutical Assistance Program (SPAP) is a state ... – PowerPoint PPT presentation

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Title: Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Deirdre Duzor Director, Pharm


1
Medicare Prescription Drug, Improvement, and
Modernization Act of 2003Deirdre
DuzorDirector, Pharmacy DivisionCenters for
Medicare Medicaid ServicesApril 26/27, 2005
2
Purpose of this presentation
  • Describe Medicaid wrap-around option
  • Describe State Pharmaceutical Assistance Program
    (SPAP) wrap-around options

3
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

4
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

5
Dual Eligible Transition
  • PDPs must have a transition plan approved by CMS
  • State Medicaid agencies may also assist by
    providing up to a 90day supply of maintenance
    drugs

6
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)

7
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

8
SPAP Options Part D (continued)
  • Combination
  • Example, pay basic premium and cost sharing

9
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)

10
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