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There
are several changes coming to the ConnPACE and Medicare Part D program
coverage in 2010, as a result of the adopted state budget:
1. Beginning January 1, 2010, the ConnPACE program will only pay Medicare
Part D Prescription Drug Plan premiums on behalf of members who are enrolled
into one of the Connecticut-approved Medicare Part D ‘benchmark’ plans. To
see a list of these plans,
please follow this link.
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If you choose to
enroll in a plan that is not a Connecticut-approved Medicare Part D
'benchmark' plan, you will be responsible for paying a monthly premium
cost to that plan. Also, if you have a Medicare Part D late enrollment
penalty, you will be responsible for paying the additional fees
associated with the penalty. Again, ConnPACE will only pay for premiums
for a Connecticut-approved Medicare Part D 'benchmark' plan. To see a
list of ALL plans,
please follow this link.
2. The ConnPACE annual enrollment fee will be increasing from $30 to $45
starting January 1, 2010. You will pay this new fee when you renew your
benefits. Please do not send in the new fee until you are asked to do so.
3.
Beginning January 1, 2010, the ConnPACE program will no longer pay for
Medicare Part D prescriptions that are not covered by your Part D plan.
These are drugs that are not in your Part D Plan’s formulary (which means
approved drug list).
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If your doctor
prescribes a drug for you that is not on your Medicare Part D Plan’s
formulary, the pharmacist should contact your physician to discuss other
drugs that are covered by your Medicare Part D Plan. Your doctor may
either change your prescription to a drug that is covered by your
Medicare Part D Plan, or may ask your Medicare Part D Plan to grant an
exception or authorization for that drug to be covered. If the specific
drug is medically necessary for you to receive and is not covered by
your Part D plan, your doctor must ask the Part D Plan for this
exception or authorization.
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It is important to
remember that this only applies to drugs that are non-formulary or
require prior authorization under your Medicare Part D Plan. Medicare
Part D excluded drugs will continue to be covered by the Department as
they have in the past (i.e. Benzodiazepines, Barbituates).
4. The ConnPACE program will establish an open enrollment period for brand
new applicants from November 15 to December 31 of each year.
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Beginning January
2010, the ConnPACE program will establish an open enrollment period that
coincides with the annual open enrollment period for the Medicare Part D
Program. The ConnPACE open enrollment period will be for new applicants
only. Current ConnPACE members will maintain their existing
re-enrollment periods.
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The open enrollment
period does not apply to you as a current ConnPACE member. You will
continue to renew your benefit in the month it is due and ConnPACE will
send you your reenrollment forms at that time. However, we wanted to let
you know about this change in case you let your ConnPACE enrollment
expire for some reason and want to re-enroll. In that case, you would
have to wait for the new enrollment period.
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We are
currently sending special notification letters to ConnPACE enrollees to
explain these changes. There are several letter versions, depending on the
member’s current status in the program.
To
view the letters, follow the links below.
Letter
A:
To ConnPACE members who are currently enrolled
in one of the 2010 Connecticut-approved Medicare Rx ‘benchmark’ prescription
drug plans.
Letter
B:
To ConnPACE members who are not currently enrolled in one of the 2010
Connecticut-approved Medicare Rx ‘benchmark’ prescription drug plans.
Letter
C: To ConnPACE members whose Medicare Rx ‘non-formulary’ drugs are now
being paid for by ConnPACE. (This letter has not been sent out yet and will
be posted when it becomes available)
Letter D:
To ConnPACE members who are
enrolled in a Medicare Advantage Plan - which provides both medical and
pharmacy coverage.
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In
addition, you need to know about some further changes IF you are a ConnPACE
member who is NOT enrolled in Medicare.
1.
ConnPACE will no longer provide for an early refill vacation supply. This
ONLY applies to ConnPACE members who are NOT enrolled in a Medicare Part D
plan.
2.
Effective October 1, 2009, the ConnPACE program is now subject to a
Preferred Drug List (PDL). The PDL is a list of prescription products
determined to be efficacious, safe, and cost-effective by the Pharmaceutical
and Therapeutics Committee (P&T Committee). A drug on the PDL is considered
a "preferred" drug. A drug that is non-preferred will not be covered by
ConnPACE unless a Prior Authorization (PA) for that drug has been approved
by the Department's contractor, Electronic Data Systems (EDS). Preferred and
non-preferred status only applies to those medications that fall within the
drug classes listed on the PDL. The HIV drug class is currently excluded
from the PDL; therefore, medications in this drug class are not subject to
preferred and non-preferred status. All strengths and dosage forms of a preferred
medication are covered unless otherwise stated. The PDL only applies to
ConnPACE members who are NOT Medicare eligible.
Click here
to see the current ConnPACE PDL.
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