Medicare

Community pharmacies provide cost-saving medication and pharmacy services to millions of Medicare Part B and D patients. Congress and the Centers for Medicare and Medicaid Services (CMS) are making changes to the program all the time. This section lists important changes that community pharmacists should know about and chronicles the NCPA Advocacy Centers efforts to ensure pharmacist can continue serving their patients and getting reimbursed appropriately for their services.

MEDICARE PART D PROGRAM

Part D is the government subsidized prescription drug program for senior citizens. The general requirement for eligibility is to be 65 years of age or older. While the government subsidizes the program, the individual prescription drug plans are run by private insurers. Part D beneficiaries also pay premiums, deductibles and co-pays for the drugs that they receive, just like private insurance. Independent community pharmacists are primary providers of the drugs that millions of senior citizens receive through the Part D program.

Rules and Regulations

Reminder of Prescription Transfer Requirements
Revalidations Mailed September through October 2011
Revalidations Mailed November through December 2011
Revalidations Mailed January 2012
Standardized MTM Format: Effective 1/1/2013
Standardized MTM Format FAQs
Medicare Prescription Drug Coverage and Your Rights PDF (19k)
Summary of Accountable Care Organizations (ACO) Final Rule PDF (60k)
New Part D Plan Information Available on CMS Plan Finder: the Centers for Medicare & Medicaid Services' Plan Finder for Medicare beneficiaries to compare and contrast Part D plans for 2013 is now operational. Open enrollment begins earlier this year—Oct. 15—and ends Dec. 7.
Summary of the CMS call letter for the 2013 Medicare Part D plan year. PDF (242k)
Summary of the CMS final rule regarding changes to the Medicare Part D program for the year 2013. PDF (211k)
Summary of changes to the Part D coverage gap or donut hole for the year 2011, as created by the health care reform legislation. PDF (27k)
Summary of new requirements in the Medicare Part D program for the year 2011, based on health care reform legislation and regulatory guidance from CMS. PDF (133k)

Regulatory Comments

Oversight Reports

MEDICARE PART B PROGRAM

Part B is government-based outpatient health care program for senior citizens over the age of 65. When a senior citizen turns 65 and begins to receive Medicare his or her benefits are generally divided into two categories, inpatient and outpatient services. Part B is the payment system for outpatient products and services. Providers, such as independent community pharmacists, receive direct payments from the government for certain outpatient products and services provided to Part B beneficiaries. Within the Part B program, independent community pharmacists primarily provide diabetes supplies, inhalation, immunosuppressive medications, and vaccines.

Rules and Regulations

Regulatory Comments

Oversight Reports

Summary of OIG report on high error rates identified by DME MAC Jurisdiction A for diabetic testing supplies. PDF (11k)

FRAUD, WASTE AND ABUSE

NCPA strongly supports government efforts to eliminate fraud, waste and abuse within the health care system. NCPA's members work hard to contribute to an efficient, cost-saving health care marketplace. However, independent community pharmacists remained concerned that some of the efforts by government and private payors to reduce fraud, waste and abuse are overly broad, abusive and actually create waste, rather than generating savings. NCPA would like government and private payors to partner more with independent community pharmacists to fight fraud, waste and abuse, while preserving patient access to much needed health care products and services.

Rules and Regulations

Regulatory Comments