At the Pharmacy Counter:
Helping Beneficiaries Get Their Prescriptions
Medicare Conference Call
Wednesday, January 17, 2007
3:00 PM ET
Throughout the 2006 Annual Enrollment Period, SHIPs reported an unexpectedly low number of requests from beneficiaries for enrollment assistance. As the second plan year commences and we move beyond enrollment, SHIPs are now focusing on accessing prescriptions at the pharmacy. As many of you are aware, problems are occurring at the pharmacy that are preventing beneficiaries from having successful transactions at the pharmacy counter. During this call we will discuss the importance of understanding all of the moving parts at the point of sale: transition, exceptions, and appeals. There will be ample time to share your success stories with the group so everyone can learn to navigate better the 2007 Part D plan year.
HAP Resources
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Helpful Information for Pharmacists - This tool provides a one-stop resource for helping pharmacists to identify the common reasons that prescription claims for Medicare beneficiaries are being denied by Part D plans. The guide also offers step-by-step solutions for each issue.
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Part D Appeals Guide - This tool provides beneficiaries and advocates with information on the reasons why a Part D Plan may refuse to cover a prescribed drug, as well as step-by-step instructions on how to file an exception or an appeal.
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Quick Guide to Exceptions for Consumers - This customizable handout may be used in the pharmacy to educate consumers about what they can do if their drugs are not covered by their Part D plans. It also provides a brief overview of the steps to request a formulary exception and, if necessary, file an appeal.
CMS Resources
Other Resources
