| On January 1, the new Medicare Part D
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| | guidance regarding the determination if a
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| program went into effect. While this
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| | medication qualifies for coverage under
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| program offers relief to the many older
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| | Medicare Part D or Part B. Some
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| Americans who had no coverage for their
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| | clarifications include:
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| medications, and who often had to decide
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| | - While certain medications given through
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| between buying food and taking their
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| | nebulizer or pump are covered under Part
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| medicine, it has offered new challenges
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| | B in a home care setting, they are not in
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| to long term care providers. Prior to
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| | the nursing home setting
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| Part D, the medications given during a
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| | - Part B covers three categories of
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| Part A Medicare stay in a nursing home
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| | drugs: oral anti-cancer, oral anti-emetic
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| was largely the responsibility of the
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| | drugs given within 24 to 48 hours of
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| nursing home, with a few exceptions. This
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| | chemotherapy and immunosuppressive drugs
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| remains the same with Part D, and the
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| | for transplants paid for by Medicare. The
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| same cost control strategies (e.g.
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| | list of these covered drugs changes
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| discontinuing use of low molecular weight
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| | frequently, and should be consulted
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| heparin medications used for prevention
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| | periodically.
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| of DVT as soon as patient is ambulatory)
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| | It is best to check with your local
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| that have been used with this population
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| | fiscal intermediary for clarification on
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| of patients are appropriate to continue.
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| | the above issues, since there may be
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| The new wrinkle is the coverage for
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| | local interpretation of Medicare
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| medications of the patients who are dual
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| | guidance. The final challenge is the long
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| eligible and not on a Part A stay-- the
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| | term care resident who is not covered by
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| chronic or long term population of
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| | Medicare at all. For these residents,
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| residents. These residents have had to
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| | their medications are not covered by Part
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| select a provider for their coverage
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| | D. In most cases they were covered by
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| under Part D, even though the medications
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| | Medicaid previously. In New York, these
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| continue to be filled by the facility
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| | residents are now covered by a small add
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| pharmacy or vendor pharmacy. Each of
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| | on to their daily rate, but many
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| these providers has a separate formulary
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| | providers are finding that this rate is
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| of covered medications. A drug that may
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| | far from adequate to cover the
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| be preferred by one provider may not be
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| | medications. Facility staff should track
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| by another. This has presented a
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| | these residents and their associated
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| challenge for facilities to educate their
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| | costs, and apply the same cost reducing
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| medical providers on these variances.
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| | strategies used for the Medicare Part A
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| Calls to physicians and nurse
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| | patients where the facility is singularly
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| practitioners from the pharmacy,
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| | responsible for the cost of the
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| laminating formulary coverage grids of
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| | medications. Part D will continue to
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| the various providers, and meetings of
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| | present a challenge throughout 2006. Be
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| staff and pharmacy consultants are
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| | sure that you are tracking your pharmacy
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| strategies that should be utilized for
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| | costs, implementing your cost reducing
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| this purpose. Medicare Part D verses Part
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| | strategies, and keeping your staff
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| B Issues: Medicare has been issuing
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| | informed of the latest facts.
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