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Life Health > Health Insurance > Medicare Planning

AHIP, Pharmacies Cut Part D Red Tape

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America’s Health Insurance Plans and pharmacy groups are trying to show that they will work quickly to solve Medicare prescription drug program startup problems.

AHIP, Washington, says it is working with the pharmacy groups and the government to speed up the creation of 2 new standardized messages dealing with rejection of Medicare Part D prescription program claims.

AHIP and the pharmacy groups also are sending the Centers for Medicare and Medicaid a batch of recommendations for improving the level of service Part D plan beneficiaries receive at community pharmacies.

The pharmacy and pharmacist groups working with AHIP on efforts to strengthen the Part D program include the National Association of Chain Drug Stores, Alexandria, Va.; the National Community Pharmacists Association, Alexandria, Va.; the American Pharmacists Association, Washington; and the Pharmaceutical Care Management Association, Washington.

Improving the new Part D program requires that “we as stakeholders roll up our sleeves, remove ourselves from silos, and work together with new partners and in new ways,” Ignagni says in a statement about AHIP’s work on the Medicare Part D program.

Representatives from AHIP and the other groups appeared here today at a press conference to describe the effort to standardize Part D messages and improve other aspects of the Part D program.

The standardized message effort would help beneficiaries understand the reason for denials and other plan actions.

The standardized message effort would group coverage denials into 2 categories:

1) Drugs that are denied because they are excluded from coverage under Medicare Part D of Medicare.

2) Drugs that are denied because they are covered under Medicare Part B.

Health plans that provide Part B coverage could start using the new standard denial messages as early as today, officials said today at the press conference.

Mark McClellan, administrator of the Centers for Medicare and Medicaid Services, attended the press conference today to show his support for the efforts to improve Part D program administration.

The new standardized message proposal also addresses other electronic claims processing messages to pharmacists.

Other messages involved deal with topics such as prior authorization requirements, daily dose limits, quantities that may be dispensed for a given prescription, and age and gender contraindications.

McClellan also has announced the formation of a Pharmacy Quality Alliance.

The PQA will measure and report pharmacy quality data, to help consumers consider quality when choosing pharmacies, officials said.


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