4. Medicare Rx

4.1 Social Security Handbook: Chapter 25: Extra Help with Medicare Prescription Drug Costs    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.ssa.gov/OP_Home/handbook/handbook.25/handbook-toc25.html

1/07

NA

SSA

Beneficiary

Link

Link

This site, web page, or URL will take you to the Table of Contents for Chapter 15 of the Social Security Handbook. This chapter covers extra help with Medicare prescription drug costs, including eligibility information, information on how to calculate your income, how to apply, and the appeals process.

4.2 Your Guide to Medicare Prescription Drug Coverage 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/Publications/Pubs/pdf/11109.pdf

12/06

76

CMS

Beneficiary

11109

This booklet helps people with Medicare understand how Medicare prescription drug coverage works, the extra help for people with limited resources and income, and how the new coverage may affect existing coverage.

Spanish

4.3 Part D Reconsideration Appeals  

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicarepartdappeals.com/

N/A

N/A

CMS

Partner

Link

This site, web page, or URL will take you to the Part D Reconsideration Appeals homepage. On this page you will be able to access various documents, including the Reconsideration Procedures Manual, Case Narrative forms, Case Files, and information about how to complete the Reconsideration Case File Transmittal form

4.4 Medicare Prescription Drug Coverage: How to Join  

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/Publications/Pubs/pdf/11111.pdf

2/07

2

CMS

Beneficiary

11111

This fact sheet provides information about how to join a prescription drug plan by visiting the plan's web site, Medicare's web site, or filling out a paper application and mailing it to the plan. It also provides guidance on when to join and where to learn more about Medicare's prescription drug coverage.

Spanish

Chinese

Korean

Russian

Tagalog

Vietnamese

4.5 Do You Have a Medigap Policy with Prescription Drug Coverage?

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/Publications/Pubs/pdf/11113.pdf

5/06

4

CMS

Beneficiary

11113

This fact sheet provides information to people who have drug coverage through a Medigap plan. It explains the different options including, enrolling in a Medicare prescription drug plan and keeping the Medigap policy, but without the prescription drug coverage, enroll in a Medicare Health Plan that includes prescription drug coverage, keep the current Medigap policy with the prescription drug coverage included, or check with your state insurance department to find out what other choices are available.  See also Medicare Options Compare (MOC - formerly known as the Medicare Personal Plan Finder).

4.6 Letter for People Who Owe Less Than $200    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/11287letter.pdf

12/06

1

CMS

Beneficiary

11287

This form or model letter was mailed to people with Medicare where CMS was unable to withhold the drug plan premium from their Social Security payment and the amount was less than $200.

Spanish

4.7 Letter for People Who Owe More Than $200    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/11288letter.pdf

12/06

1

CMS

Beneficiary

11288

This form or model letter was mailed to people with Medicare where CMS was unable to withhold the drug plan premium from their Social Security payment and the amount was more than $200.

Spanish

4.8 Letter for People Who Will Get a Refund 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/11289letter.pdf

12/06

1

CMS

Beneficiary

11289

This form or model letter was mailed to people with Medicare where CMS withheld too much for drug premiums.  It explains that the overpayment will be refunded.

Spanish

4.9 Information Partners Can Use On: Calculating the Late Enrollment Penalty    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/lateenrollment.pdf

10/06

3

CMS

Partner

11222-P

This tip sheet provides examples of people with Medicare that will be responsible for paying a penalty and examples for calculating the late enrollment penalty.

Spanish

4.10 Things to Think About When You Compare Plans 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/Publications/Pubs/pdf/11163.pdf

11/06

8

CMS

Beneficiary

11163

This fact sheet identifies what a person should consider before selecting a prescription drug plan such as cost (premium, deductible, co-payment/coinsurance), coverage (formulary, prior authorization, and coverage gap), convenience, and piece of mind. There is a chart provided which serves as a guide to identify what type of plan should be considered. Additionally, it provides guidance on the type of information to have available when using the Medicare Prescription Drug Plan Finder (MPDPF).

Spanish

4.11 Information Partners Can Use On: Understanding the True Out of Pocket (TrOOP) Costs    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/troop.pdf

10/06

4

CMS

Partner

11223-P

This tip sheet explains the costs that do and do not count towards the TrOOP.

Spanish

4.12 Information Partners Can Use On: How the Coverage Gap Works for People with Medicare Prescription Drug Plans    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/11240P.pdf

3/07

5

CMS

Partner

11240

This tip sheet explains how the gap in coverage works for people with Medicare prescription drug plans. 

Spanish

4.13 Information Partners Can Use On: How Annual Cost is Calculated    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/hacic.pdf

3/06

3

CMS

Partner

11245

This tip sheet explains that the annual cost is a sum calculated by adding the premium for a year and the amount a person with Medicare pays during different times throughout their coverage. 

Spanish

4.14 Information Partners Can Use On: Using Medicare Prescription Drug Coverage Before Receiving a Drug Plan Membership Card    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/march1reminder.pdf

3/06

1

CMS

Partner

11257-P

This tip sheet identifies the acceptable temporary substitutes for a drug plan membership card.

4.15 Getting Drugs After Your Transition Period

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/WhatIfTransition_option2.pdf

3/06

1

CMS

Beneficiary

Tool

This job aid, visual aid, or tool instructs the Medicare beneficiary of the steps they should take if they arrive at the pharmacy and the drug prescribed by their physician is not covered by their plan and the transition period has expired.

4.16 Information Partners Can Use on Joining and Switching Medicare Drug Plans

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/
joiningandswitch6-15-06.pdf

6/06

3

CMS

Partner

Tip Sheet

This tip sheet explains when people with Medicare can join plan, what to do if they want to switch plans after they have joined, and what they should know based on their existing coverage. 

Spanish

4.17 Information Partners Can Use on Encouraging Early-in-Month Enrollments 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/
earlyinmonthtipsheet.pdf

2/06

2

CMS

Partner

Tip Sheet

This tip sheet advises partners on how to counsel people with Medicare to join a plan early in the month to avoid unnecessary delays in prescription drug coverage and to ensure the plan has all the necessary information to process their claims.

4.18 Information Partners Can Use on How Annual Cost is Calculated 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/hacic.pdf

3/06

3

CMS

Partner

Tip Sheet

This tip sheet explains how the true out of pocket (TROOP) is calculated. It explains the deductible, ICP, coverage gap, and catastrophic coverage and gives useful examples.

Spanish

4.19 Formulary Changes during the Plan Year – Memo from CMS to Plans

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PrescriptionDrugCovContra/
downloads/MemoFormularyChangeGuidance_04.27.06.pdf

4/06

4

CMS

Partner

Notice

This latest notice from CMS to Medicare Rx plans informs them of formulary modification restrictions requiring that all changes negatively affecting beneficiaries are to be submitted to CMS for review and approval. The memo also describes the principles and criteria used to review plan requests for formulary changes during the course of the plan year.

4.20 My Medicines

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/Publications/Pubs/pdf/11085.pdf

10/04

2

CMS

Beneficiary

11085

This fact sheet provides a table/tool to record prescribed drugs and suggests questions that people with Medicare should ask their physician. It also provides tips to review the warnings, ingredients, and expiration date on all medications.

4.21 Your Guide to Special Needs Plans-CURRENTLY IN DEVELOPMENT 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

TBD

CMS

11302

This publication will provide information regarding Special Needs Plans (SNPs).

 4.22. Information Partners Can Use On: January Premium Withhold Mailing    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/11290P.pdf

1/07

2

CMS

Partner

11290-P

This tip sheet explains that as part of a year-end reconciliation process, Medicare compared its payment and enrollment files against Social Security’s premium withhold files to ensure that people are having the correct Medicare health plan or prescription drug plan premium amounts withheld from their Social Security payments. As a result of this process, Medicare is mailing letters to people who selected premium withhold for 2006, but for which the premiums withheld were incorrect. Also provided are explanations of the letters mailed.

Spanish

4.23 Quick Facts about Medicare's Coverage for Prescription Drugs 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/Publications/Pubs/pdf/11102.pdf

2/07

2

CMS

Beneficiary

11102

This fact sheet contains quick facts explaining enrollment and coverage gap, and the other 5 facts people should know about the Medicare prescription drug coverage.

Spanish

Chinese

American Indians and Alaskan Natives

Korean

Russian

Tagalog

Vietnamese

4.24 Part D Performance Data 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/06_PerformanceData.asp

2/07

N/A

CMS

Partner

Link

The Medicare Drug Coverage Performance Data web page is a central location for Medicare drug plan performance data. Data include contract level complaint rates and call center wait times.

4.25 Enrollment Activity on May 15^th

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1858

5/06

1

CMS

Beneficiary

Fact Sheet

This historical fact sheet provides enrollment statistics, outreach events, and Medicare resource (1-800-Medicare and www.medicare.gov) activity statistics.

4.26 Time Is Running Out - May 15th Enrollment Deadline Nears

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.hhs.gov/news/press/2006pres/20060508.html

5/06

1

CMS

Beneficiary

Notice

This historical press release or notice identified enrollment efforts underway via outreach and the enrollment center bus.

4.27 Open Enrollment Toolkit    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/OpenEnrollmentToolkit.zip

12/06

N/A

CMS

Partner

Toolkit

This toolkit contains a variety of publications, print ads, flyers, brochures, drop-in articles, and live read PSAs surrounding the 2007 open enrollment period.   Included in this zipped file are 41 files containing materials in English and Spanish.

4.28 What You Should Know About Social Security Premium Withholds

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.medicare.gov/Publications/Pubs/pdf/11202.pdf

5/06

1

CMS

Beneficiary

11202

This fact sheet gives people with Medicare information on what to expect when they choose to have their Medicare drug plan premiums withheld from their regular Social Security benefit payment. To view an alternate version of this publication with more detailed information, see publication 11200.

4.29 How Medicare Drug Plan Members can seek Repayment of Premiums and Copayments-CURRENTLY IN DEVELOPMENT 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

TBD

CMS

11246-P

This publication will provide information about how Medicare Drug Plan Members can seek repayment of premiums and copayments.

4.30 Information Partners Can Use on: Special Needs Plans- CURRENTLY IN DEVELOPMENT 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

TBD

CMS

Partner

11275-P

This tip sheet will provide information on Special Needs Plans (SNPs)

4.31 Beneficiary Communications & Enrollment Timeline

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://nncf.unl.edu/medicare/pdf/enroll_timeline.pdf

9/06

1

CMS

Partner

Tool

This job aid, visual aid, or tool describes the 2007 beneficiary communications and enrollment timeline.

4.32 The Formulary Finder

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://formularyfinder.medicare.gov/formularyfinder/selectstate.asp

9/06

N/A

CMS

Partner

Tool

The Formulary Finder is an online tool to help people with Medicare find plans in their state that match their required drug list.  To view a plan's entire formulary and download their Appeals and Exception forms, click here to find plan Web sites by state.

4.33 Information Partners Can Use On: January Premium Withholding Mailing    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/11290P.pdf

1/07

2

CMS

Partner

11290-P

The partner tip sheet provides more information about the mailing and the two letters mailed in January 2007.

4.34 Information Partners Can Use on: People on Medicare who Have HIV/AIDS

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/AIDS.pdf

2/06

4

CMS

Partner

11252-P

This tip sheet provides information partners can use for prescription drug coverage: People With Medicare and HIV/AIDS.  For more information on Medicare Part D, Ryan White CARE Act, and ADAP visit the Human Resource Services Administration (HRSA) HIV/AIDS Bureau (May 2006).

Spanish

4.35 Counseling Aids

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/MLNProducts/Downloads/
counseling_aides.zip

2/06

N/A

CMS

Partner

Tool

This job aid, visual aid, or tool (2.3MB, zipped file) contains posters and tips for counseling about the Medicare Prescription Drug Coverage.

4.36 Medicare Part D Coverage Determination Request Form

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/MLNProducts/Downloads/
educational_products.zip

4/06

N/A

CMS

Partner

Tool

This job aid, visual aid, or tool (zipped file) contains numerous communications and products to assist providers in working with People with Medicare and understanding Medicare Part D. This includes print ready materials, ads, calendars, posters, flyers, bookmarks, and much more. It includes the 2006 Transitional toolkit.

4.37 Request for Prescription Information or Change

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/Downloads/
PartDPharmacyFaxForm.pdf

N/A

1

CMS

Partner

Form

Use this optional form when the prescribing physician and pharmacist need to communicate prescription changes and other information with a plan.

4.38 Creditable Coverage Notice – CMS Guidance

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

www.cms.hhs.gov/CreditableCoverage/Downloads/
Disclosure2CMSGdnc.pdf

1/06

5

CMS

Partner

Notice

This latest notice provides guidance to Employers, Plan Administrators, VA, Other Health Plans, Medigap, Supplemental Insurers, on the responsibilities in terms of identifying creditable coverage to CMS and the beneficiary - Creditable Regulatory Requirements

4.39 Updated Creditable Coverage Guidance & Model Notices
Posted in Federal Register for an Additional 30 Day Public Comment Period  

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/
edocket.access.gpo.gov/2006/pdf/E6-18006.pdf

9/06

N/A

CMS

Partner

Sample

Draft reference library (174KB zipped).  It includes a sample or model letter, mailing, or notice.  On September 22, 2006, CMS published in the Federal Register a request for Paperwork Reduction Act (PRA) comments on updated Creditable Coverage model notices that entities can use when disclosing creditable coverage status to beneficiaries. (The package also includes conforming changes to previously released Creditable Coverage guidance.) The proposed changes are in response to comments received on the model notices published in May 2006. Please note that plan sponsors can continue to provide creditable coverage disclosures using the May 2006 model disclosure notices and guidance, or they can use the updated notices and guidance until CMS finalize and release the materials.  Learn more.  NOTE:  Same as section 5.28

4.40 Medicare Prescription Drug Plan Preferred Terminology for Consumers

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

www.cms.hhs.gov/partnerships/downloads/preferredterms.pdf

7/05

3

CMS

Partner

Tool

This 2005 job aid, visual aid, or tool contains language, specific to Medicare Prescription Drug Coverage that resonates well with people with Medicare.

Spanish

4.41 Job Aid - Medicare Prescription Drug Coverage Scripts for Partners 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/scripts.pdf

3/07

632

CMS

Partner

Tool

This job aid, visual aid, or tool includes CMS Customer Service Representative (CSR) Scripts, which can be used to facilitate decision-making for persons calling the 1-800-MEDICARE helpline. Currently many people with Medicare have some form of drug coverage. The best decision a person with Medicare can make varies based on type of current coverage. Different population segments identified are Low Income, Employer/Retiree, Medigap, and General Population. In an effort to provide the person with Medicare information that is appropriate for them or their situation, scripts have been developed to address each group.

4.42 Part D Drugs/Part D Excluded Drugs

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/
PartDDrugsPartDExcludedDrugs_04.19.06.pdf

4/06

4

CMS

Partner

Tool

This job aid, visual aid, or tool provides clarification explaining Part D coverage for specific products/drugs/drug categories in accordance with statutory and regulatory requirements for Part D drugs. This is not an exhaustive list but only addresses those products/drugs/drug categories that have been the subject of frequently asked questions. Always evaluate the specific products not identified in this table against the statutory and regulatory definition of a “Part D drug” before drawing conclusions from this table. This table does not address B versus D coverage questions.

4.43 Medicare Parts B versus Part D Coverage Issues

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/
BvsDCoverage_07.27.05.pdf

7/05

42

CMS

Partner

Tool

This job aid, visual aid, or tool (table) provides clarification and offers a quick and easy reference guide for the most frequent Part B/D coverage determination scenarios facing Part D plans and Part D pharmacy providers. It does not address all potential situations.

4.44 What if Scenarios for Pharmacies

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/Pharmacy/Downloads/
WhatIfScenariosPharm.pdf

2/06

9

CMS

Partner

Tool

This job aid, visual aid, or tool describes cases or scenarios that equip the pharmacy with point-of service (POS) tips on how to handle specific situations involving people with Medicare that have prescription drug coverage.

4.45 Point-Of-Service (POS) Facilitated Enrollment Process in Four Steps for Pharmacists

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/Pharmacy/Downloads/
PharmacyPOSQA_01.18.06.pdf

1/06

3

CMS

Partner

Tool

This tool (tip sheet) explains the steps the pharmacy can take to assist in enrolling a person with new Medicare prescription drug coverage into a plan when they arrive at the pharmacy without having already selected a prescription drug plan.

4.46 What if Scenarios for Coordination of Benefits (COB)

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/Downloads/
WhatIfCOB_01.04.06.pdf

1/06

2

CMS

Partner

Tool

This job aid, visual aid, or tool describes cases or scenarios that prepare pharmacies to take appropriate action in counseling a person with Medicare about Medicare Rx, based on the type of coverage an individual with Medicare currently has.

4.47 Medicare Drug Coverage Under Part A, Part B, and Part D

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/determine.pdf

2/06

9

CMS

Partner

Reference

This clarification, or reference was provided to doctors and practitioners to explain and differentiate coverage of prescription drugs under Medicare Parts A, B and D.

4.48 Script for Medicare Part D Pharmacy Training

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PharmacyTraining/Downloads/
PartDPharmacyTrainingScript.pdf

12/05

10

CMS

Partner

Classroom

This is a transcript of the CMS pharmacy classroom training presentation developed to address five topics of special interest to pharmacies participating in the Medicare prescription drug program. Topics covered include: Pharmacy Electronic Transactions; Point-of Sale Facilitated Enrollment of Dual Beneficiaries; Katrina Out-of-Network Access; Coverage of Drugs: Medicaid versus Medicare, and Medicare Part B versus Part D.

4.49 CMS 2006 National Medicare Multi-Media & Education Campaign – Print, Internet, Radio, and Television Ads (English & Spanish)    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/Partnerships/NACM/list.asp?filterType=
none&filterByDID=0&sortByDID=4&sortOrder=descending

3/07

N/A

CMS

Partner

Tool

 NOTE:  Also check for latest 2007 My Health. My Medicare campaign materials, or visit the CMS partner center for future updates! Library of outreach tools listing English & Spanish National Ad Campaign Materials for the national advertising campaign. It includes television (TV) and radio Public Service Announcements (PSAs), Flyers, Drop-in articles for printed media (print ads, newsletters, newspapers); English and Spanish. Example shows 400-word drop-in article is useful as a template for use in public service announcements about 2007 Medicare Rx Enrollment Check-up. It describes how with prescription drug coverage, Medicare covers more than ever - Everyone with Medicare is eligible for this coverage, regardless of income, health status, or current prescription expenses.  See also Quick Tips on Your First Pharmacy Trip.

4.50 Getting Drugs After the Transition Period

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/States/Downloads/
GettingDrugsAftertheTransitionPeriod.zip

4/06

N/A

CMS

Partner

Reference

This reference includes materials regarding the end of the extended transition period following initial implementation of Medicare Rx: CMS Transition Fact Sheet, Critical Steps as Transition Period Ends, and a "What If" document to the getting drugs after the transition period.

4.51 Medicare Prescription Drug Coverage Personal Information Worksheet   

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/NationalMedicareTrainingProgram/
Downloads/MPDCPInfoWorksheet.pdf

10/06

4

CMS

Partner

Tool

Use this worksheet, job aid, visual aid, or tool to capture beneficiary information necessary to complete a comparison on the Medicare Prescription Drug Plan Finder (MPDPF).  It is very useful as an outreach tool for personalized counseling sessions, or during community outreach enrollment sessions. Check the Training Library for updates.

Spanish

4.52 Frequently Asked Questions (FAQ) – Formulary Changes during the Operational Plan Year

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

www.cms.hhs.gov/PrescriptionDrugCovContra/downloads/
QAFormularyChangesDuringPlanYear_05.05.06.pdf

5/06

5

CMS

Partner

Tool

FAQ tool includes questions and answers (QA, or Q&A) fielded by CMS from Medicare Rx plans regarding plan requirements when changing plan formularies submitted to CMS for review; includes instructions on making positive ad negative formulary changes, as well as notification requirements when enhancing a formulary.

4.53 Medicare Rx Training for Healthcare Professionals

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/MLNProducts/Downloads/med_rx_train.zip

5/06

56

CMS

Partner

Classroom

Train healthcare professionals about Medicare Rx with this set of zipped Classroom training slides (PowerPoint). The presentation consists of 56 slides and is over 7MB when downloaded.

4.54 Educational Products for Healthcare Professionals – Medicare Learning Network (MLN) Library 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/MLNProducts/23_drugcoverage.asp

5/06

N/A

CMS

Partner

Library

This library of educational products equips healthcare professionals with tools to explain to their patients the Medicare prescription drug coverage, the Extra Help, types of plans/coverage, Medicare preventive services and other Medicare related topics. As a trusted source, patients may ask their health care providers for information about Medicare preventive services, or the new Medicare prescription drug coverage. CMS encourages the provider community to become familiar with these educational products and asks the provider community to take advantage of "teachable moments" by helping Medicare patients understand their options.

4.55 Medicare Prescription Drug Benefit Manual: Chapter 7 – Medication Therapy Management and Quality Improvement Program 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/PrescriptionDrugCovContra/
Downloads/PDBManual_Chapter7.pdf

12/06

25

CMS

Partner

Reference

The draft version of Chapter 7 of the Medicare Part D Manual provides information on Quality Assurance Requirements, Medication Therapy Management, E-prescribing, and Drug Utilization Management.

4.56 Information Folder: Medicare Prescription Drug Coverage 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/NationalMedicareTrainProg/
09_Information%20Folder.asp

7/06

N/A

CMS

Partner

11179

This job aid, visual aid, or tool is a streamlined version of outreach and awareness materials provided in the Medicare Prescription Drug Coverage Outreach Toolkit. This folder is easily customizable for specific target audiences by collating available fact sheets to provide basic education on the Medicare prescription drug coverage, relevant to unique situations or groups. It contains: Key messages; Training on a simple approach to outreach (“So You’re Conducting Outreach”); a PowerPoint presentation “Medicare Today, More Choices, Better Benefits”; Information about Extra Help; the Medicare Rx Calendar of Important Dates; and a list of additional Helpful Resources. Files are zipped and are more than 13MB when downloaded. To discuss availability, contact mailto:BSPGtraining@cms.hhs.gov. 

Spanish

4.57 Outreach Toolkit: Medicare Prescription Drug Coverage

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/NationalMedicareTrainProg/
08_Medicare Prescription Drug Coverage Outreach Tooklit.asp

7/06

N/A

CMS

Partner

11177

This Outreach Toolkit is a job aid, visual aid, or tool designed to equip community-level organizations with the materials needed to provide clear, accurate information and assistance to their clients on the Medicare Program, including the new Medicare prescription drug coverage. Use this toolkit (20 MB, zipped) to simplify complex topics and convey them to beneficiaries, as it offers basic, straightforward information.

4.58 Train-the-Trainer Module 9A: Your Medicare Prescription Drug Coverage    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/NationalMedicareTrainingProgram/TL/list.asp

4/07

26

CMS

Partner

Classroom

This introductory classroom training module on Medicare Rx used in face-to-face Train the Trainer workshops consists of PowerPoint slides with Speaker’s notes.. The training module provides basic, easy-to-understand information about Medicare prescription drug coverage (Medicare Part D) for people with Medicare and those who assist them with their Medicare decisions. Zipped file (12MB) includes updates on other timely Medicare topics – Welcome to Medicare! (For people just joining Medicare); Medicare 101 (for partners new to Medicare); Medicare Preventive Services (introductory); Navigating the Medicare Prescription Drug Plan Finder (hands-on introduction); Current Topics (detailed legislative & Part D updates).  Future updates will be posted in the Training Library.

Spanish

4.59 Train-the-Trainer Module 10. Medicare Prescription Drug Coverage STAR

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/NationalMedicareTrainingProgram/TL/list.asp

4/07

112

CMS

Partner

Classroom

NOTE:  This is an outdated module – please do not use. That is why this link does not work by clicking on it!  Instead, see latest version of reference 4.58 above.  Used last year as an in-depth classroom training module on Medicare Rx - consists of PowerPoint slides with Speaker’s notes for face-to-face, Train-the-Trainer workshops. This training module described in detail what CMS partners needed to know about the then-new Medicare prescription drug coverage. Future updates will be posted in the Training Library.  

4.60 Medicare Rx Coverage Part A, Part B, and Part D Basics

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/NationalMedicareTrainProg/
Downloads/RxCoveragePartABD.pdf

3/06

5

CMS

Partner

Tool

Medicare Part A and Part B generally do not cover outpatient prescription drugs, most of which are now covered under Part D. This job aid, visual aid, or tool is designed to help someone determine which part of Medicare covers a drug in a particular situation, assuming all other requirements are met, e.g., a drug must still be medically necessary to be covered. This information is for people in the Original Medicare Plan. People who have a Medicare Advantage HMO or PPO Plan with prescription drug coverage get all their Medicare-covered health care from the plan, including prescription drugs.

4.61 Medicare Drug Coverage: Part A, Part B, Part D - Desk Aid

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/NationalMedicareTrainProg/
Downloads/RxCoverageDeskAid.pdf

3/06

2

CMS

Partner

Tool

This job aid, visual aid, or tool identifies Medicare coverage of medically necessary drugs in some common situations. It provides general guidance only and does not cover all possible situations. Learn more.

 4.62 Make the Most of Your Medicare Drug Plan Options by Comparing Plan Performance    

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/11226%20Drug
%20Plan%20on%20www.medicare%2011-8-06.pdf

11/06

1

CMS

Beneficiary

11226

This publication explains the information available on the Medicare Prescription Drug Plan Finder (MPDPF).  The information will help people with Medicare choose and join a plan that meets his/her needs and that performed well in the categories including telephone customer service, complaints, appeals, information sharing with pharmacists, and drug pricing.

4.63 Outreach and Education to American Indian/Alaska Native – Library

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/AIAN/

12/05

N/A

CMS

Partner

Library

Library of resources suitable for outreach and education to American Indian (AI), Alaska Native (AN) population, to help address the unique health needs of American Indians/Alaska Natives. CMS is committed to maximizing American Indian/Alaska Native access to Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) through consultation with Tribes, culturally competent outreach and education, and other specific programs. 

4.64 Prescription Drug Information for Partners – Library 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/Partnerships/PDI/list.asp#TopOfPage, including http://www.cms.hhs.gov/partnerships/downloads/benebookmark.pdf

3/07

N/A

CMS

Partner

Library

Library of 2005 outreach tools and resources designed to get family and friends involved with helping people with Medicare choose a Medicare prescription drug plan. It contains 24 items: CMS Regional Contacts for the MMA Educational Campaign, Key Messages about Medicare Rx, a set of vignettes, a bookmark template and graphics. Use these vignettes to design interactive exercises during workshops or conferences addressing Medicare Rx, as they describe scenarios and encourage problem solving to help explain how Medicare prescription drug coverage works with/affects other types of health care coverage. The bookmark is also available in Spanish and for distribution by librarians (below).

Spanish

Librarians

4.65 Part D Reference Guide for Pharmacists 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/Pharmacy/downloads/Part%20D%20
Reference%20Document%20for%20Pharmacists_1106.pdf

10/06

14

CMS

Partner

Reference

This reference provides a variety of helpful websites for pharmacists related to Part D.

Spanish (14MB)

4.66 Ready, Set, GO! Event Resource Guide – Outreach Toolkit 

Web Address

Pub Date

No. of Pages

Published By

Appropriate

Audience

Pub Number/ Type

http://www.cms.hhs.gov/partnerships/downloads/Ready_Set_Go.pdf

1/06

31

CMS

Partner

Tool

This job aid, visual aid, or tool can be used to plan, develop, or implement an outreach or educational event about the new Medicare Rx, or during an opportunity for personalized counseling about joining a Medicare drug plan. With your help, the people with Medicare within your state, county, and/or neighborhood will be able to receive the new benefits to which they are entitled.

4.67 True-Out-Of-Pocket (TrOOP) Facilitator – Contact

Web Address