Kidney Medicare Drugs Awareness and Education Initiative

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Medicare How Its Changing To Help More People
Helping Patients Choose a Medicare Part D Plan

• Presented by
• Kidney Medicare Drugs
• Awareness and Education Initiative
• www.kidneydrugcoverage.org

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• Welcome Linda Keegan, Executive Director, KCP
• Patient advocates
• Dialysis professionals
• Dialysis providers and suppliers
• KCPs goal
• Improve quality of care for those with kidney
  failure
• KCP stimulated creation of Kidney Medicare Drugs
  Awareness and Education Initiative

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KIDNEY MEDICARE DRUGS AWARENESS AND EDUCATION
INITIATIVEA kidney community effort to help
professionals and people with kidney disease
understand Medicare prescription drug coverage
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Participating Organizations

• Abbott Laboratories
• American Association of Kidney Patients, Inc.
• American Kidney Fund
• American Nephrology Nurses Association
• The American Society of Nephrology
• Amgen
• Astellas Pharma US, Inc.
• Centers for Medicare Medicaid Services
• Central Florida Kidney Center, Inc.
• DaVita, Inc.
• DaVita Patient Citizens
• The ESRD Network of New York
• Fresenius Medical Care North America
• Gambro Healthcare US
• Genzyme Corporation
• Kidney Care Partners
• National Kidney Foundation, Inc.
• Council of Nephrology Nurses and Technicians
• Council of Nephrology Social Workers

• National Minority Health Month Foundation
• National Renal Administrators Association
• Novartis Pharmaceuticals Corporation
• People Like Us, National Kidney Foundation
• Pfizer Inc.
• Pharmaceutical Research and Manufacturers of
  America
• PKD Foundation
• Renal Care Group, Inc.
• The Renal Network, Inc.
• Renal Physicians Association
• Renal Support Network
• Roche Pharmaceuticals
• Sigma-Tau Pharmaceuticals, Inc.
• Social Security Administration
• Transplant News
• The Transplant Pharmacy Coalition
• UnitedHealth Group/Ovations
• Washington Hospital Center
• Wyeth Pharmaceuticals

5
Prior Teleconferences in Series

• August 16 teleconference upcoming changes and
  extra help for those with limited income and
  resources
• September 20 teleconference coverage
  coordination
• Archived materials from teleconferences on
  www.kidneydrugcoverage.org

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Medicare Part D Overview

• November 15, 2005 First date to join a Medicare
  drug plan
• Those with Medicare and Medicaid must join by
  December 31, 2005 or Medicare will choose their
  plan for January 1, 2006
• May 15, 2006 Last date for people with Medicare
  now to join
• People need to know their options to make the
  best decision for them

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Our Experts

• Moderator
• Maureen McKinley, DaVita social worker, past
  chair of National Kidney Foundation Council of
  Nephrology Social Workers
• Speakers
• Tom Dudley, Division of Website Project
  Management, Centers for Medicare Medicaid
  Services
• Patricia Fuller, Division of Beneficiary Choices,
  Beneficiary Information Services, Centers for
  Medicare Medicaid Services
• Nancy Oliker, Director of Part D Education,
  UnitedHealth Group, a national prescription drug
  plan provider
• Wendy St. Peter, Pharmacist, member of ESRD
  Network 8 technical advisory panel, Outpatient
  ESRD Medications

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Who Needs Medicare Part D

• Will help many with Medicare with some drugs, but
  if drug coverage is as good as Part D, may not
  need it
• Plan sponsors creditable coverage notice
• Notifies if on average coverage is good as the
  standard Medicare prescription drug coverage

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About Medicare Part D

• Coverage is not free
• One in three Medicare beneficiaries may qualify
  for extra help
• If have limited income and resources
• Notice told who gets extra help automatically
• If no notice, but think may qualify
• Visit www.socialsecurity.gov
• Call 1-800-772-1213 (TTY 1-800-325-0778)
• No creditable coverage -- look at options

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Key Factors in Choosing a Plan

• Coverage
• Cost
• Convenience

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What to Look For

• A broad formulary
• Before kidney failure, dialysis, transplant
• Total annual cost for each plan
• Premiums, deductibles, cost shares at all
  coverage levels
• Accessibility
• What pharmacy choices (retail, mail order)
• Snowbirds consider plans in both states or that
  provide drug access outside plan area

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Medicare Part D Covered Drugs

• Must cover all or substantially all
• Cancer medicines
• HIV/AIDS drugs
• Anti-depressants
• Anti-psychotics
• Anti-convulsants
• Immunosuppressants
• May not cover every brand name or all doses
• Other categories, must cover at least 2 per class

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Standard Part D Excluded Drugs

• Anorexia, weight loss, weight gain
• Fertility drugs
• Cosmetic purposes, like hair growth
• Cold and cough medicines
• Non-prescription or over-the-counter
• Barbiturates (e.g. Seconal, Nembutal)
• Benzodiazepines (e.g. Restoril, Ativan)
• Vitamins and minerals
• Except prenatal vitamins, fluoride preparations,
  Vitamin D
• Enhanced plans may cover excluded drugs

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How to Find Out Covered Drugs

• Contact every plan provider in area
• Time consuming with number of plans
• Use Medicare Prescription Drug Plan Finder tool
• Provides customized cost sharing information
  (PDPs, MA-PDs, Special Needs Plans)
• Considers patients eligibility for extra help

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Using Drug Plan Finder Tool

• Authentication Route
• Enter personal information
• Confirms identity with Medicare Beneficiary
  Database
• Provides customized information with personal
  data
• General Search Route
• Use if dont have 5 key data elements
• Use if dont choose to enter personal information
• Provides general information based on answers
  given
• Enroll Directly Route
• Use if have done research
• Enroll with plans starting November 15

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What You Learn From Drug Plan Finder Tool

• Includes what plans choose to include
• Formulary information
• Network pharmacy information
• Beneficiary cost sharing information
• Deductibles, premiums, co-pays, coinsurance
• Whether patient is likely to reach coverage gap
  (catastrophic coverage level)

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Online Enrollment Center

• Available November 15, 2005
• Accepts enrollments into plans that opt to
  participate in Online Enrollment Center
• PDPs
• MA-PDs

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Preparing to Use the Drug Plan Finder Tool

• List drugs, dosages, number per month
• Look up what drugs cost now
• Search for up to 25 drugs at a time
• Searching for pharmacies
• If do now, may narrow options
• Can look later once tool compares plans

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Comparing Plans Online

• Can compare up to 3 plans side-by-side
• Premium, deductible, cost share
• Pharmacy network
• Whether prior authorization is needed
• Spanish version available November 15
• Americans with Disabilities Act compliant
• Larger text options
• Can be used with screen readers
• People can use libraries or ask others for help

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Options other than Internet?

• Medicare You 2006 booklet
• Contacts for PDPs and MA-PD plans
• Spanish version available January 2006
• 1-800-MEDICARE or 1-877-486-2048 (TTY)
• Customer service representatives use Medicare
  Drug Plan Finder tool to compare plans if shares
  personal information and drugs
• Can mail out print-on-demand booklet
• Can mail other Medicare booklets
• See CSR scripts at www.cms.hhs.gov/partnerships
• November 15, 2005 First date CSRs can enroll

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Determining Cost of Plan

• Use authentication option to find cost share
  based on subsidy level
• Drug Plan Finder online www.medicare.gov
• 1-800-MEDICARE
• Enrolled in a drug plan already?
• Employer claiming subsidy?

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Standard Medicare Drug Plan
Plans vary by region and coverage.
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For Those Without Extra Help

• For drugs costing 5,100 in 2006, they pay 3,600
  with possible help from
• Family or friends
• State Pharmacy Assistance Program (SPAP)
• Charities
• Over 5,100 in 2006, they pay
• 5 of covered drug costs or
• 2 (generic) or 5 (brand name)

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Low Income Subsidy
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Enrolling in a Plan

• Only Medicare beneficiaries can enroll or legal
  representatives can enroll them
• Online at plans website or www.medicare.gov
• Phone to plan or 1-800-MEDICARE
• Mail application to plan
• Plan receives application and mails enrollment
  packet and ID card

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Premium Payment Options

• Automatic deduction from Social Security or
  Railroad Retirement check
• Pay by check
• Electronic transfer from bank account
• Billed to a credit card

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Contact the Plan to Learn

• Network pharmacies in the network
• Costs of the plan
• Covered drugs (formulary)
• Medical condition
• Alphabetically

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Plans Formularies

• CMS approves formulary changes
• Plans must update CMS
• Monthly on formulary changes
• Weekly on price changes
• Plans must give 60-days notice of formulary
  change
• Plan does not have to give advance notice if FDA
  removes a drug as unsafe
• Most changes occur when for new drugs added
• Call customer service for questions

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Options When Formulary Changes

• Switch to another drug in category
• Ask plan what other drugs are covered
• Talk with doctor options
• File an exception request if drug is medically
  necessary
• Change plans everyone can change at least once
  a year November 15-December 31
• NOTE Topic of November 15 teleconference --
  Coverage determination and exception requests

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Generics or Brand Name Drugs?

• Plans will cover generics and brand name drugs
• Plans may encourage generic use
• Plans may have drugs on tiers
• Tier 1 Generic drugs
• Tier 2 Preferred brand name drugs
• Tier 3 Expensive, non-preferred brand name
  drugs

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About Network Pharmacies

• Plan networks
• Preferred pharmacies
• Non-preferred pharmacies
• Costs will be higher at non-preferred ones
• Show ID to avoid paying full price

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Finding Network Pharmacies Without the Internet

• To search plan directories of preferred and
  non-preferred pharmacies
• Call plans customer service department
• Call 1-800-MEDICARE or 1-877-486-2048 (TTY)

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Especially for Rural Patients

• Find pharmacy options in Medicare Prescription
  Drug Plan Finder Tool
• Which plans have mail order options
• Cost for prescriptions through mail order

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Pharmacy Changes

• Plans can add any time
• Plans can remove any time
• Plans more likely to remove if pharmacy closes
• To get most current list
• Visit plans website
• Call plans customer service department

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Drug Limits at Pharmacies

• Limit may be 30-day supply (retail)
• Limit may be 90-day supply (mail order)
• 90-day supply from mail order pharmacy may cost
  less than 3 times co-pay
• Retail pharmacies may offer more than 30-day
  supply for price similar to mail order
• May order all or some drugs by mail order
  pharmacy to save money and for convenience
• Plans must tell members all ways to order drugs

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Case StudyPerson on Dialysis

• Nephrocaps 1 qd
• Renagel 800mg 2 tabs w/meals and snacks
• Sensipar 30mg 1 qd
• Cardiazem CD 1 qd (G)
• Prinivil 10 mg 1 qd (G)
• Zocor 80 mg 1 qd
• Glucotrol 10 mg 1bid (G)
• Aspirin EC 325mg 1qd (G)

• Darvocet 1 q8 hour prn (G)
• Ativan 0.5mg 1 q8 hour (G)
• Ambien 5mg 1 q HS
• Epogen 3,000 IU every dialysis
• Venofer 100mg IV qowk
• Zemplar 5mcg IV q dialysis

G Available in generic
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Case StudyTransplant Recipient

• Prograf 1mg 2 bid
• Cellcept 500mg 2 bid
• Deltasone 5mg 1qd (G)
• Diflucan 100mg 1qd (G)
• Bactrim 1 qd (G)
• Protonix 40mg 1qd

• Valcyte 450mg 2 bid
• Zantac 150mg 1 qd (G)
• Lantus 22 IU _at_HS
• Humalog 5 IU _at_meals
• Prinivil 10mg qd (G)
• Zocor 80 mg _at_HS

G Available in generic
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Information about Drug Status from Case Studies

• Some drugs are excluded
• Vitamins, aspirin, Ativan
• Drugs covered under Part B
• Epogen, Zemplar, Venofer, Prograf, Cellcept,
  Deltasone
• Excluded drugs and Part B drugs do not count
  toward 3,600 in true out-of-pocket costs
• Part D may cover all other drugs
• Generic drugs may cost less
• Immunosuppressants could be covered under Part D
  if not eligible for coverage under Part B
• When Medicare ends, Part D ends too

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Diabetes and Part B or Part D

• Medicare Part B covered
• Diabetes meters
• Test strips
• Lancets
• Medicare Part D may cover
• Syringes and needles
• Gauze and alcohol swabs
• Insulin delivery devices (pens supplies)

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Tips to Save the Most on Medicare Drug Plans

• Search for most expensive drugs first
• Search for these drugs on lowest tiers
• Try to avoid plans requiring prior authorization
• Search for less expensive drugs consider
  generics
• Look for convenient pharmacy network

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Remember Resources for Choosing a Plan

• Medicare Prescription Drug Finder Plan
• www.medicare.gov
• Medicare customer service representatives
• 1-800-MEDICARE
• Kidney-specific information
• www.kidneydrugcoverage.org

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Thank You

• Moderator
• Maureen McKinley, DaVita social worker, past
  chair of National Kidney Foundation Council of
  Nephrology Social Workers
• Speakers
• Tom Dudley, Division of Website Project
  Management, Centers for Medicare Medicaid
  Services
• Patricia Fuller, Division of Beneficiary Choices,
  Beneficiary Information Services, Centers for
  Medicare Medicaid Services
• Nancy Oliker, Director of Part D Education,
  UnitedHealth Group, a national prescription drug
  plan provider
• Wendy St. Peter, Pharmacist, member of ESRD
  Network 8 technical advisory panel, Outpatient
  ESRD Medications

43
Key Messages

• Medicare drug plan will help some others may not
  need it
• Most information you read is for the average
  person with Medicare
• Kidney Medicare Drugs Awareness and Education
  Initiative provides kidney-specific information
• Kidney friendly plans provide the most help
• Ask patients to bring notices to review, advise
  about creditable coverage, keep for appeals

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The right information at the right time
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Thank You For Participating

• Listen at noon ET on November 15, 2005 for
  information on impact of tiers, utilization
  management, coverage determinations exceptions,
  and medication management therapy
• Visit www.kidneydrugcoverage.org for todays
  materials
• Complete evaluation
• Print your certificate of attendance
• Ask your licensing board if certificate can be
  used for continuing education credit
• Submit questions about Medicare Part D to
  info_at_kidneydrugcoverage.org