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Medicare Part D: Is the glass half full?. Christine A. Rivera, Director Uninsured Care Programs New York State Department of Health 518.459.1641 Empire Station, PO BOX 2052 Albany NY 12220-0052.

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Medicare part d is the glass half full

Medicare Part D: Is the glass half full?

Christine A. Rivera, Director

Uninsured Care Programs

New York State Department of Health


Empire Station, PO BOX 2052

Albany NY 12220-0052

Thanks to Laura Caruso, formerly Director of Health Policy for Gay Mens’ Health Crisis, NYC. This presentation is an adaptation of her work for the ADAP Report Advisory Board.

Half empty
Half Empty?

  • This is not the benefit the HIV community wanted – it’s the one we’ve got

  • Making Part D work for people requires collaboration, patience and flexibility

  • ADAPs play an integral role in the HIV/AIDS Part D puzzle in each state - not just for ADAP enrollees – we are trusted in the community

Challenges present opportunities
Challenges present opportunities?

  • Each person, state and organization experiences Part D differently. The complexity of the benefit makes sharing information difficult and developing best practices a lonely endeavor

  • Technical, policy and implementation questions are being answered through experience

  • Implementation and utilization of Part D is problematic for consumers, advocates, and ADAPs

Challenges for the hiv aids community
Challenges for the HIV/AIDS community

  • Mass media and CMS campaigns are focused on seniors making it more confusing for disabled consumers

  • Opportunities for federal and state trainings are limited and not practical on an organizational level, not all staff can go, cost and time constraints

  • There are few resources available for people with disabilities who need help and guidance

Challenges for consumers
Challenges for consumers

Navigation issues

  • Website is difficult to work with especially for individuals with low literacy or those who do not have computer skills

  • Mailings can be difficult to understand.

  • Availability of information and resources in other languages is lacking

  • Pharmacy network and access issues need to be communicated in easy to understand terms

Challenges for consumers1
Challenges for consumers

Policy issues

  • Selecting a plan, benchmark plans vs. enhanced plans

  • Interaction and interface with other sources of drug coverage, e.g. ADAP and Medicaid spend-down

  • Exception and coverage determination processes can be complex and pose barriers to care

Challenges for adaps
Challenges for ADAPs

We are responsible for:

  • Responding to the concerns of consumers trying to negotiate enrollment and utilization of Part D

  • Developing materials appropriate for our participants

  • Assuming the cost of Coordinating Benefits with Part D and developing systems to defer costs associated with participant enrollment in Part D

  • Monitoring and responding to client experiences in Part D plans

  • Developing systems to report on the impact of Part D

Fostering collaboration
Fostering collaboration

How do we make this work?

  • ADAPs play a unique and vital role in states’ HIV communities and can help bring organizations and people together

  • NASTAD has been critical partner in national Part D conversations on behalf of beneficiaries

Fostering collaboration1
Fostering collaboration

  • Monitoring and feedback is needed at all levels

  • Continue to work with national and local groups to keep informed of the changes and challenges

  • Partnering with local organizations to save resources and avoid duplicating efforts

  • Keeping our messages simple – we need to avoid adding to the confusion