Medicare Prescription
Drug Coverage
Todd Stankewicz, RPh, MPH, MBA
Acting Associate Regional Administrator
CMS - Chicago
Session Objectives
This session will help you to
 Describe how Health Care Reform will impact
Medicare beneficiaries in 2014
 Recognize Medicare prescription drug coverage
• Under Medicare Part A (Hospital Insurance),
Part B (Medical Insurance), and Part D
 Summarize eligibility and enrollment
 Compare and choose plans
 Describe the Medication Therapy Management
program
2
Affordable Care Act Timeline
3
Before the Affordable Care Act…
 Insurance companies could turn away the 129 million
Americans with pre-existing conditions
 Premiums had more than doubled over the last
decade, while insurance company profits were
soaring
 Tens of millions were underinsured, and many who
had coverage were afraid of losing it
 50 million Americans had no insurance at all
4
The Health Care Law
In March 2010, President Obama signed the Affordable
Care Act into law
5
Affordable Care Act –
Coverage Accomplishments
 New Survey of Young Adults: 7.8 Million Gained New
or Better Coverage Through Affordable Care Act
 7.3 million seniors and people with disabilities who
reached the donut hole in their Medicare Part D
(Medicare Prescription Drug Coverage) plans have saved $8.9
billion on their prescription drugs
 16.5 million people with traditional Medicare took advantage of
at least one free preventive service in the first six months of
2013.
 71 million privately insured people gained improved
coverage for preventive services
6
Affordable Care Act –
Cost Savings
 Slowest sustained national health spending growth in 50
years
• Low growth continuing in 2013 for Medicare and Medicaid
 Rate increases fell from 75% in 2010 to 14% so far in
2013
 $500 million was returned to consumers this summer and $1
billion was returned last summer
• Plans now must spend 80% on healthcare
 $4.2 billion recovered in 2012 from anti-fraud efforts – a
record high – for a total of nearly $15 billion over the last
4 years, double that of the previous 4 years
7
A Look Ahead
August 2013
October 1, 2013
 Expect training to begin for
Open enrollment in the Health
consumer assisters like Navigators, Insurance Marketplace begins
as well as for agents and brokers
 SHOP (Employer) Call Center live






January 1, 2014
Coverage through Health Insurance Marketplace begins (as early as)
Discrimination due to pre-existing conditions or gender is prohibited
Annual Limits on Insurance Coverage will be eliminated
Advanced Premium Tax Credits will be available
The Small Business Tax Credit will increase
More people will be eligible for Medicaid (in some states)
8
People with Medicare
Medicare isn’t part of the Marketplace
• In most cases it will be to your advantage to sign up for or
keep Medicare




You may pay more for coverage in the Marketplace
You may have to pay a penalty for Medicare Parts A, B, and D
if you choose to sign up for Medicare later
You won’t be eligible for lower costs to help pay your
premiums or cost-sharing in the Marketplace
If you’re in the Marketplace when you become eligible for
Medicare, you lose any tax credit/cost-sharing reduction you
may have had
9
Medicare Prescription
Drug Coverage Basics
 Medicare overview
 Medicare prescription drug coverage under
• Part A (Hospital Insurance)
• Part B (Medical Insurance)
10
The Four Parts of Medicare
Part A
Hospital
Insurance
Part B
Medical
Insurance
Part C
Medicare
Advantage
Plans (like
HMOs/PPOs)
Part D
Medicare
Prescription
Drug
Coverage
Includes Part A,
Part B and
sometimes Part
D coverage
11
Medicare Prescription Drug Coverage
 Prescription drug coverage under Part A, B,
or D depends on
• Medical necessity
• Health care setting
• Medical indication
• Any special drug coverage requirements
12
Part A Prescription Drug Coverage
 Part A generally pays for all drugs during a
covered inpatient stay
• In hospital or skilled nursing facility (SNF)
 Drugs received as part of treatment
• Hospice
 Drugs for symptom control and pain relief only
6
Part B Prescription Drug Coverage
 Part B covers limited outpatient drugs
• Injectable and infusible drugs that are
 Not usually self-administered, and
 Administered as part of a physician service
• Administered through Part B-covered Durable
Medicare Equipment (DME)
 Such as nebulizers and infusion pumps
 Only when used with DME in your home
14
Part B Prescription Drug Coverage
 Part B covers limited outpatient drugs
• Some oral drugs with special coverage requirements
 Anti-cancer drugs
 Anti-emetic drugs
 Immunosuppressive drugs, under certain
circumstances
• Certain immunizations
 Flu shot
 Pneumococcal pneumonia vaccine
15
Part B Prescription Drug Coverage
 Generally doesn’t cover self-administered
drugs in hospital outpatient setting
• Unless required for hospital services you’re
receiving
 If enrolled in Part D, drugs may be covered
• If not admitted to hospital
• May have to pay and submit for reimbursement
16
Medicare Part D
Benefits and Costs
 Medicare prescription drug coverage
 Medicare drug plan benefits and costs
17
Medicare Prescription Drug Coverage






Also called Medicare Part D
Prescription drug plans approved by Medicare
Run by private companies
Available to everyone with Medicare
Must be enrolled in a plan to get coverage
Two sources of coverage
• Medicare Prescription Drug Plans (PDPs)
• Medicare Advantage Plans with Rx coverage (MA-PDs)

And other Medicare health plans with Rx coverage
18
Medicare Drug Plans
 Can be flexible in benefit design
 Must offer at least a standard level of coverage
 May offer different or enhanced benefits
• Lower deductible
• Different tier and/or copayment levels
• Coverage for drugs not typically covered by Part D
 Benefits and costs may change each year
19
Medicare Drug Plan Costs
 Costs vary by plan
 In 2014, most people will pay
•
•
•
•
•
•
A monthly premium
A yearly deductible
Copayments or coinsurance
47.5% for covered brand-name drugs in coverage gap
72% for covered generic drugs in coverage gap
Very little after spending $4,550 out-of-pocket
20
Standard Structure in 2014
Ms. Smith joins the ABC Prescription Drug Plan. Her coverage begins on January 1, 2014. She
doesn’t get Extra Help and uses her Medicare drug plan membership card when she buys
prescriptions.
Monthly Premium – Ms. Smith pays a monthly premium throughout the year.
1. Yearly
2. Copayment or
deductible
coinsurance
(what you pay at
the pharmacy)
3. Coverage gap
4. Catastrophic
coverage
Ms. Smith pays
the first $310 of
her drug costs
before her plan
starts to pay its
share.
Once Ms. Smith and her plan have
spent $2,850 for covered drugs, she’s in
the coverage gap. In 2014, she pays
47.5% of the plan’s cost for her covered
brand-name prescription drugs and
72% of the plan’s cost for covered
generic drugs. What she pays (and the
discount paid by the drug company)
counts as out-of-pocket spending, and
helps her get out of the coverage gap.
Once Ms. Smith has
spent $4,550 out-ofpocket for the year,
her coverage gap
ends. Now she only
pays a small
coinsurance or
copayment for each
covered drug until
the end of the 21
year.
Ms. Smith pays a
copayment, and her
plan pays its share for
each covered drug until
their combined amount
(plus the deductible)
reaches $2,850.
Brand-Name Prescription Drug Savings in the
Coverage Gap
100%
90%
80%
50
50
47.5
47.5
45
45
35
40
25
30
70%
60%
50%
100
2.5
2.5
5
5
15
10
25
20
40%
30%
50
50
50
50
50
50
50
50
50
50
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
20%
10%
0%
2010
Brand-Name Prescription Drug Savings in the Coverage Gap
Manufacturer Discount
Plan Pays
Beneficiary Pays
22
Generic Drug Cost Sharing: 2010-2020
100%
90%
25
37
80%
44
51
58
70%
65
72
79
60%
86
93
50%
100
40%
75
63
30%
56
49
42
20%
35
28
21
10%
14
7
0%
0
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Generic Drug Savings in the Coverage Gap
Plan Pays
Beneficiary Pays
23
True Out-of-Pocket (TrOOP) Costs
 Expenses that count toward your out-of-pocket
threshold
• $4,550 in 2014
 After threshold you get catastrophic coverage
• Pay only small copayment or coinsurance for
covered drugs
 Explanation of Benefits (EOB) shows TrOOP
costs to date
 TrOOP transfers if you switch plans mid-year
24
Which Payment Sources Count Toward TrOOP?
Sources That Count
Sources That Don’t Count
 Payments made by you, your
family members, or friends
 Qualified State Pharmacy
Assistance Programs (SPAPs)
 Medicare’s Extra Help
 Most charities (not if established
or run by employer/union)
 Indian Health Services
 AIDS Drug Assistance Programs
 The discount you get on covered
brand-name drugs in the coverage
gap
 Your monthly plan premium
 Share of the drug cost paid by your
Medicare drug plan
 Group Health Plans (including
employer/union retiree coverage)
 Government-funded programs
(including Medicaid, TRICARE, VA)
 Patient Assistance Programs (PAPs)
 Other third-party payment
arrangements
 Other types of insurance
 The discount you get on covered
generic drugs in the coverage gap
25
Medicare Part D
Drug Coverage
 Covered and non-covered drugs
 Access to covered drugs
26
Part D-Covered Drugs
 Prescription brand-name and generic drugs
• Approved by Food and Drug Administration (FDA)
• Used and sold in United States
• Used for medically-accepted indications
 Includes drugs, biological products, and insulin
• Supplies associated with injection of insulin
 Plans must cover range of drugs in each category
 Coverage and rules vary by plan
27
Required Coverage
 All drugs in 6 protected categories
•
•
•
•
•
•
Cancer medications
HIV/AIDS treatments
Antidepressants
Antipsychotic medications
Anticonvulsive treatments
Immunosuppressants
 All commercially-available vaccines
• Except those covered under Part B (e.g., flu shot)
28
Drugs Excluded by Law Under Part D
 Drugs for Anorexia, weight loss, or weight gain
 Erectile dysfunction drugs when used for the
treatment of sexual or erectile dysfunction
 Fertility drugs
 Drugs for cosmetic or lifestyle purposes
 Drugs for symptomatic relief of coughs and colds
 Prescription vitamin and mineral products
 Non-prescription drugs
29
Formulary
 A list of prescription drugs covered by the plan
 May have tiers that cost different amounts
Tier Structure Example
Tier
You Pay
Prescription
Drugs Covered
1
Lowest copayment
Most generics
2
Medium copayment
Preferred, brand-name
3
High copayment
Non-preferred, brand-name
Highest copayment
or coinsurance
Unique, very high-cost
Specialty
30
Formulary Changes
 Plans may change categories and classes
• Only at beginning of each plan year
• May make maintenance changes during year
 e.g., replacing brand-name drug with new generic
 Plan usually must notify you 60 days before changes
• May be able to use drug until end of calendar year
• May ask for exception if other drugs don’t work
 Plans may remove drugs withdrawn from market
without 60-day notification
31
Rules Plans Use to Manage Access to Drugs
Prior
Authorization
 Doctor must contact plan for prior approval
before drug will be covered
• Must show medical necessity for drug
Step Therapy
 Type of prior authorization
 Must first try similar, less expensive drug
 Doctor may request an exception if
• Similar, less expensive drug didn’t work, or
• Step therapy drug is medically necessary
Quantity Limits
 Plan may limit drug quantities over a period of
time for safety and/or cost
 Doctor may request an exception if additional
amount is medically necessary
32
If Your Prescription Changes
 Get up-to-date formulary information from plan
• By phone or on plan’s website
 Give doctor copy of plan’s formulary
 If the new drug isn’t on plan’s formulary
• Can request a coverage determination from plan
• May have to pay full price if plan still won’t cover
33
Comparing and Choosing Plans
 Things to consider
 Steps to choosing a Medicare drug plan
 What to expect
34
Things to Consider Before Joining a Plan
 Important questions to ask
• Do you have other current health insurance coverage?
• What about current prescription drug coverage?
 Is any prescription drug coverage you might have
as good as Medicare drug coverage?
• How does your current coverage work with Medicare?
 Could joining a plan affect your current coverage?
 Or affect a family member’s coverage?
35
Step 1: Prepare
 Prepare by gathering together information
•
•
•
•
•
Current prescription drug coverage
Prescription drugs, dosages, and quantities
Preferred pharmacies
Medicare card
ZIP code
36
Step 2: Compare Using Medicare Plan Finder
 Search for drug and
health plans
 Personalize your search
to find plans that meet
your needs
 Compare plans based on
star ratings, benefits,
costs, and more
 Enroll in a plan
37
Step 3: Decide and Join
 Decide which plan is best for you and enroll
• Online enrollment
 www.medicare.gov
 Plan’s website
• Enroll by phone
 1-800-MEDICARE (1-800-633-4227)
 TTY users should call 1-877-486-2048
 Call plan
• Mail or fax paper application to plan
38
What New Members Can Expect
• Your plan will send you
• An enrollment letter
• Membership materials, including card
• Customer service contact information
 If your current drug isn’t covered by plan
• You can get a transition supply (generally 30 days)
• Work with prescriber to find a drug that’s covered
• Request exception if no acceptable alternative
drug is on the list
39
Annual Notice of Change (ANOC)
 All Medicare drug plans must send ANOC to
members by September 30th
• May be sent with Evidence of Coverage
 Will include information for upcoming year
• Summary of Benefits
• Formulary
• Changes to monthly premium and/or cost sharing
 Read ANOC carefully and compare your plan
with other plan options
40
5-Star Special Enrollment Period (SEP)
 Can enroll in 5-Star Medicare Advantage (MA),
Prescription Drug Plan (PDP), MA-PD, or Cost Plan
 Enroll at any point during the year
• Once per year
 New plan starts first day of month after enrolled
 Star ratings given once a year
• Ratings assigned in October of the past year
• Use Medicare Plan Finder to see star ratings

Look at Overall Plan Rating to find eligible plans
41
Results: Many More Medicare Advantage Enrollees in 4- and 5Star Plans
2009
4-star
16%
Medicare Advantage Enrollment
2012
4-star
28%
5-star,
0%
2-star
14%
5-star
9%
2-star
6%
3-star
57%
3-star
70%
2009
2012
2-3 star plans
84%
63%
4-5 star plans
16%
37%
Source: Percentages based on 2009 and 2012 MA enrollment statistics, compared using 2013 star rating methodology.
42
Medicare Part D
Medication Therapy Management
 Qualifying for a MTM program
 Services provided to beneficiaries enrolled in
MTM programs
43
MTM: 2013 Dollar Cost Threshold
• “Sponsors must target beneficiaries who meet the other
two criteria and who are likely to incur annual costs for
Part D drugs of at least $3,017.”
• The cost threshold is adjusted each year by an annual
percentage based on data from the previous year’s
expenditures.
44
Provider of MTM Services
• “May be furnished by a pharmacist or other qualified
provider;”
Percent of plans utilizing each provider type
45
MTM Services 2013
• Must target beneficiaries AND prescribers
• Offer a Comprehensive Medication Review (CMR)
by a pharmacist or other qualified provider at least
annually to all targeted beneficiaries enrolled in the
MTM program (including LTC beneficiaries)
• Interactive, person-to-person or telehealth
consultations
• Quarterly targeted medication reviews (TMRs) with
follow-up interventions when necessary
46
Written Summary of CMR
• An individualized, written summary using
CMS’ standardized format must be provided to
the beneficiary, or to the beneficiary’s
prescriber, caregiver, or other authorized
representative
• Includes three components:
•Cover Letter
•Medication Action Plan
•Personal Medication List
47
Required MTM Services
CMR Summary Delivery Method
• Almost 95% of programs provide the CMR summary in
CMS’ standardized format by mail. Over 22% also
provide the summary in person after the CMR
Required MTM Services
CMR Delivery Method
• 92.4% of programs offer the interactive, personto-person CMR consultation via the phone.
• Over 40% (42.4%) of programs also offer faceto-face consultations (up from 28.4% in 2012)
• 16% of programs offer CMRs through telehealth
technologies (up from 1% in 2012).
Outcomes Measurement
• “Sponsors are expected to have a process in place to:
– measure, analyze, and report the outcomes of their MTM
programs,
– determine whether or not goals of therapy have been
reached;
– capture drug therapy recommendations and resolutions
made as a result of the MTM recommendations; and
– capture beneficiary satisfaction with MTM services,
providers, and outcomes.”
50
Medicare Prescription Drug Coverage Resource Guide
Resources
www.medicare.gov
1-800-MEDICARE (1-800-633-4227)
(TTY users should call 1-877-466-2048)
Prescription Drug Benefit Manual
http://www.cms.gov/Medicare/PrescriptionDrug-Coverage/PrescriptionDrugCovContra/
PartDManuals.html
PDP Enrollment and Disenrollment Guidance
http://www.cms.gov/Medicare/Eligibility-andEnrollment/MedicarePresDrugEligEnrol/index.
html
Local State Health Insurance Programs
www.medicare.gov/contacts
Centers for Medicare & Medicaid Services
www.cms.gov
Social Security
1-800-772-1213
www.socialsecurity.gov
Medicare Products
RxAssist
A directory of Patient Assistance
Programs (PAPs)
www.rxassist.org
Medicare Part D Appeals
www.medicarepartdappeals.com
Determining the Part B incomerelated premium
SSA publication 10161 available at
http://www.socialsecurity.gov/pubs
/10536.pdf
Medicare & You Handbook
CMS (Product No. 10050)
Your Guide to Medicare
Prescription Drug Coverage
(CMS Product No. 11109)
Your Medicare Benefits
(CMS Product No. 10116)
To get these products:
View and order single copies:
www.medicare.gov
Order multiple copies
(partners only):
productordering.cms.hhs.gov
(You must register your
organization)
Medicare’s Limited Income NET Program
1-800-783-1307 or 1-877-801-0369 (TTY)
e-mail : MedicareLINET@cms.hhs.gov
Affordable Care Act
www.healthcare.gov/law/full/index.html
51
This training module is provided by the
CMS National Training Program
For questions about training products e-mail
training@cms.hhs.gov
To view all available CMS National Training Program materials,
or to subscribe to our e-mail list, visit
http://cms.gov/Outreach-and-Education/Training/CMSNationalTrainingProgram
Appendix A: Part B-Covered
Oral Anticancer Drugs*







Busulfan
Capecitabine
Cyclophosphamide
Etoposide
Melphalan
Methotrexate
Temozolomide
*List is subject to change
53
Appendix B: Part B-Covered Oral Anti-Emetics
for Use Within 48 Hours of Chemotherapy*
 3 oral drug combination of
• Aprepitant
• A 5-HT3 Antagonist
• Dexamethasone
 Chlorpromazine Hydrochloride
 Diphenhydramine Hydrochloride
 Dolasetron Mesylate
(within 24 hours)
 Dronabinol
 Granisetron Hydrochloride
(within 24 hours)
 Hydroxyzine Pamoate
 Ondansetron Hydrochloride
 Nabilone
 Perphenazine
 Prochlorperazine Maleate
 Promethazine Hydrochloride
 Trimethobenzamide
Hydrochloride
*List is subject to change
54
Appendix C: Part B-Covered
Immunosuppressive Drugs*







Azathioprine-oral
Azathioprine-parenteral
Cyclophosphamide-oral
Cyclosporine-oral
Cyclosporine-parenteral
Daclizumab-parenteral
Lymphocyte Immune Globulin,
Antithymocyte Globulin-parenteral
 Methotrexate-oral
 Methylprednisolone-oral
 Methylprednisolone Sodium
Succinate Injection
 Muromonab-Cd3-parenteral
 Mycophenolate Acid-oral
 Mycophenolate Mofetil-oral
 Prednisolone-oral
 Prednisone-oral
 Sirolimus-oral
 Tacrolimus-oral
 Tacrolimus-parenteral
*List is subject to change
55
Appendix D: 2013 Standard Drug Benefit
Benefit Parameters
2013
2014
$325
$310
Initial Coverage Limit
$2,970.00
$2,850.00
Out-of-Pocket Threshold
$4,750.00
$4,550.00
Total Covered Drug Spending at OOP Threshold
$6,954.52
$6,690.77
Minimum Cost-Sharing in Catastrophic Coverage
$2.65/$6.60
$2.55/$6.35
Extra Help Copayments
2013
2014
Institutionalized
$0
$0
Receiving Home and Community-Based Services
$0
$0
Up to or at 100% Federal Poverty Level (FPL)
$1.15/$3.50
$1.20/$3.60
Full Extra Help
$2.65/$6.60
$2.55/$6.35
$66/15%
$63/15%
Deductible
Partial Extra Help (Deductible/Cost-Sharing)
56
Appendix E: Medicare Drug Plan Costs if
You Automatically Qualify for Extra Help
If you have Medicare and…
Your
monthly
premium
Your yearly
deductible
Your cost per prescription
at the pharmacy
(until $4,750*)
Your cost per
prescription
at the pharmacy
(after $4,750*)
Full Medicaid coverage for each full month you
live in an institution, like a nursing home
$0
$0
Full Medicaid coverage and have
a yearly income at or below
$11,490 (single)
$15,510 (married)
$0
$0
Generic and certain preferred drugs:
no more than $1.15
Brand-name drugs:
no more than $3.50
$0
Full Medicaid coverage and have
a yearly income above
$11,490 (single)
$15,510 (married)
$0
$0
Generic and certain preferred drugs:
no more than $2.65
Brand-name drugs:
no more than $6.60
$0
Help from Medicaid paying your Medicare Part B
premiums
$0
$0
Generic and certain preferred drugs:
no more than $2.65
Brand-name drugs:
no more than $6.60
$0
Supplemental Security Income (SSI)
$0
$0
Generic and certain preferred drugs:
no more than $2.65
Brand-name drugs:
no more than $6.60
$0
$0
$0
Note: There are plans you can join and pay no premium. There are other plans where you will have to pay part of the premium even when you automatically qualify for Extra
Help. Tell you plan you qualify for Extra Help and ask how much you will pay for your monthly premium. **Your cost per prescription generally decreases once the amount
you pay and Medicare pays as the Extra Help reach $4,750 per year. The cost sharing, income levels, and resources listed are for 2013 and can increase each year. Income
levels are higher if you live in Alaska or Hawaii, or you or your spouse pays at least half of the living expenses of dependent family members who live with you, or you work.
57
Appendix E: Medicare Drug Plan Costs if
You Apply and Qualify for Extra Help
Your cost per
prescription
at the pharmacy
(until $4,750*)
Your
monthly
premium
Your
yearly
deductible
A yearly income below
$15,511.50 (single) $20,938.50 (married)
with resources of no more than
$8,580 (single)
$13,620 (married)
$0
$0
A yearly income below
$15,511.50 (single) $20,938.50 (married)
with resources between
$8,580 and $13,330 (single)
$13,620 and $26,580 (married)
A yearly income between
$15,511.50 and $16,086 (single)
$20,938.50 and $21,714 (married)
with resources up to
$13,330 (single) $26,580 (married)
$0
$66
25%
$66
up to 15% of the cost of each
prescription
50%
$66
up to 15% of the cost of each
prescription
75%
$66
up to 15% of the cost of each
prescription
If you have Medicare and…
A yearly income between
$15,638 and $16,660.50 (single)
$21,182 and $22,489.50 (married)
with resources up to
$13,330 (single) $26,580 (married)
A yearly income between
$16,660.50 and $17,235 (single)
$21,938.50 and $23,265 (married)
with resources up to
$13,330 (single) $26,580 (married)
Generic and certain
preferred drugs:
no more than $2.65
Brand-name drugs:
no more than $6.60
up to 15% of the cost of each
prescription
Your cost per
prescription
at the pharmacy
(after $4,750*)
$0
Generic and certain
preferred drugs:
no more than $2.65
Brand-name drugs:
no more than $6.60
Generic and certain
preferred drugs:
no more than $2.65
Brand-name drugs:
no more than $6.60
Generic and certain
preferred drugs:
no more than $2.65
Brand-name drugs:
no more than $6.60
Generic and certain
preferred drugs:
no more than $2.65
Brand-name drugs:
no more than $6.60
58
Appendix F: Guide to Consumer Mailings
59
Appendix F: Guide to Consumer Mailings
60
Appendix F: Guide to Consumer Mailings
61
Appendix F: Guide to Consumer Mailings
62
Appendix F: Guide to Consumer Mailings
63
Appendix G: How Do You Access Medicare’s
Limited Income NET Program?
Auto-Enrollment
by CMS
Point of Sale
(POS) Use
Submit a Receipt
• CMS auto-enrolls you if you have
Medicare and get either full Medicaid
coverage or SSI benefits
• You may use Medicare’s Limited Income
NET Program at the pharmacy counter
(point-of-sale)
• You may submit pharmacy receipts (not
just a cashier’s receipt) for prescriptions
you already paid for out-of-pocket during
periods you’re eligible
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Appendix G: Medicare’s Limited Income
Newly Eligible Transition (NET) Program
 Resources to help pharmacists submit claims
• Program Help Desk: 1-800-783-1307
• Address: The Medicare Limited Income NET Program
P.O. Box 14310
Lexington, KY 40512-4310
• Websites


http://www.cms.gov/Medicare/Eligibility-andEnrollment/LowIncSubMedicarePresCov/MedicareLimit
edIncomeNET.html
http://www.humana.com/pharmacists/pharmacy_resou
rces/information.aspx
• CMS Mailbox: MedicareLINET@cms.hhs.gov
65
Appendix H:
Levels of
Appeal
66