ConnPACE - Connecticut Department of Social Services

Pharmaceutical Assistance Contract to the Elderly and Disabled

 

Upcoming Changes to the ConnPACE Program

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.

  • 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.

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).

  • 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.

  • 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.

  • 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.

  • 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.

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.

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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.