• • About the Part D Benefit
  • Education and Counseling
  • Medicare Advantage
  • Extra Help
  • General Medicare

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Problems and Solutions at the Pharmacy

• 2008 Point-of-Sale Enrollment Solution

Here is 2008 CMS policy on the point-of-sale enrollment solution that pharmacists can use to enroll Extra Help beneficiaries who are not in a Part D plan into a WellPoint plan so that prescriptions can be filled immediately. Remember that as new enrollees, point-of-sale enrollees should receive transition fills.

Here is a brochure on the point-of-sale enrollment solution that CMS prepared for state stakeholders.

• 2007 4-Step Point of Sale Enrollment (January 2007)

  Pharmacists can follow this 4-Step process (50Kb PDF file) to enroll people with both Medicare and Medicaid who are not in a Part D plan into a stop-gap plan in order to fill prescriptions at the point of sale.

• Health Care Professional’s Part D Fact Sheet

  The CMS Health Care Professional’s Part D Fact Sheet (35Kb PDF file) contains links and contact information for plans and Medicare appeals contractors.

• Pharmacists - Part D Reference Guide

  This Medicare Part D reference guide (138Kb PDF file) is for pharmacists.

• Pharmacy-to-Doctor Fax Form

  When a pharmacist learns through the electronic system used to process claims at the point-of-sale that a plan will not permit a prescription to be filled, the pharmacist can fax this form to the prescribing physician.

  This form will hasten the discussions and decisions that must quickly be made about whether to:

  • Seek a coverage determination or exception to the formulary from the plan, OR
  • Switch to a different dosage strength or drug that is on the plan’s formulary, OR
  • Both.

This fax form was developed by a group representing key national physician, pharmacy and beneficiary advocacy organizations and endorsed by CMS.

• Using a New Part D Plan at the Pharmacy, (CMS, December 2007)

This CMS Tip Sheet is for Medicare beneficiaries who switched into new Part D plans for 2008.  It includes hints for all new Part D plan members as well as a description of the Best Available Evidence policy in simple language for people with Medicare and Medicaid.