The new plan year for Medicare Part D began January 1 and many beneficiaries, particularly low-income subsidy individuals who were reassigned, are adjusting to new plans or to new rules in their current plans. During the first three months of the plan year, beneficiaries have a limited right to transition supplies of drugs that may not be on their plan formulary or that may be subject to utilization management requirements. Plans also are required to clearly inform members receiving transition supplies about the next steps available to them.
To assist advocates in understanding the transition rights of their clients, NSCLC has prepared the attached fact sheet.
The Centers for Medicare and Medicaid Services has warned plans that the agency is watching closely to determine whether plans are acting consistent with CMS requirements. We urge advocates who encounter transition policy problems to report them to CMS, even if the client is ultimately able to obtain needed medications.
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