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CHALLENGES OF MANAGING THE MEDICARE PART D BENEFIT

CHALLENGES OF MANAGING THE MEDICARE PART D BENEFIT. Craig S. Stern, RPh, PharmD, MBA PBMI Town Hall Forum February 28, 2008. OUTLINE. Options Issues for 2008 Discussion. OPTIONS. Subsidy Wrap MA-PD / PD. ISSUES FOR 2008. Payer Issues Eligibility Enrollment COB

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CHALLENGES OF MANAGING THE MEDICARE PART D BENEFIT

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  1. CHALLENGES OF MANAGING THE MEDICARE PART D BENEFIT Craig S. Stern, RPh, PharmD, MBA PBMI Town Hall Forum February 28, 2008

  2. OUTLINE • Options • Issues for 2008 • Discussion

  3. OPTIONS • Subsidy • Wrap • MA-PD / PD

  4. ISSUES FOR 2008 • Payer Issues • Eligibility • Enrollment • COB • Formulary Changes • Vaccines • Transparency • Audits • Pharmacy Issues • Prompt pay

  5. Enrollment / Eligibility Issues • Timeliness • Re-up • Auditing

  6. Coordination of Benefits (COB) • Part D Exclusions • Part B Covered

  7. Formulary Issues • Member Disruption • Member Access • Copay / Deductible / Donut Hole

  8. Vaccines • Payment Issues • Medication cost • Administration charge

  9. Audits • Compliance • Financial Transparency • Formulary • Prompt Pay

  10. DISCUSSION POINTS • Experience 2007 • Hot Topics • Challenges • Resources

  11. PRO PHARMA PHARMACEUTICAL CONSULTANTS, INC. P.O. Box 280130 Northridge, CA 91328-0130 (818) 701-5438 (818) 701-0249 Fax Email: craig.stern@propharmaconsultants.com …or Visit Our Website at: www.propharmaconsultants.com

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