New Medicare Gap Coverage Discount Program from CMS

One of the main provisions of the Affordable Care Act that kicked off on the first of January when Medicare recipients who received Part D but do not benefit from the low-income grant “Extra Help” started to receive a discount of 50% under the Medicare Coverage Gap Discount Program with the purchase of applicable drugs. Seniors benefiting from Medicare also were granted a 7% bump up in coverage for all additionally covered Part D drugs when they are in the gap.

Many pharmacies are doing the following to ready themselves for this new program:

• Supply Chain Management – It is a good idea for pharmacies to review the labeler codes from the list on the CMS website with contractors from Part D to figure out if the drugs that are inventoried there are applicable.

• Staff Education - Employees of the pharmacy need to be ready to answer questions and discuss the program with patients, so staff education should be one of the first things to consider.

Benefits for covered drugs will be augmented over the next 10 years, in which case, seniors who have Medicare end up paying less in the coverage gap. It is the plan that by 2020, this gap will have closed and eligible seniors will be paying just 25% for their covered drugs up until they meet their out-of-pocket maximum.