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Medicare Part D/Alaska Medicaid contingency plan for prescription drugs stabilized, ends

April 3, 2006

Emergency plan no longer needed as Medicare program stabilizes

(Juneau , Alaska) – The Medicare Part D/Alaska Medicaid program has stabilized and the emergency plan put into place beginning January 1, 2006 is no longer necessary. The Department of Health and Social Services stopped purchasing Medicare-covered prescription medication for Medicaid dual-eligible clients on April 1, 2006. However, the department will continue to pay for certain classes of drugs covered by Medicaid that are not covered by Medicare.

Due to the stabilization of implementation of the Medicare Part D, DHSS does not anticipate that the cessation of the state's emergency contingency plan will cause an interruption in prescription services for those individuals dual eligible for Medicare and Medicaid.

The department has notified pharmacies statewide of the cessation of the contingency plan. “The department greatly appreciates the care that pharmacist and technicians provided to Alaska Medicaid dual-eligible clients during the difficult Medicare Part D transition,” Health Care Services Division Director Dwayne Peeples said.

Forty-six states carried out similar contingency plans and many have already met deadlines that stopped payments to pharmacies for dual eligible recipients. Alaska extended its contingency plan to March 31, 2006 - beyond most other states' deadlines.

In anticipation of implementation of the new Medicare Part D program, Alaska implemented a contingency plan to provide a backup for the Medicaid dual-eligible population should problems arise. Part of the contingency plan allowed pharmacies to bill Alaska Medicaid for Medicaid recipients if Medicare pharmacy benefit plan enrollment could not be verified through the federal Center of Medicaid and Medicare Services and various plan data bases. Eleven companies and 27 different Medicare plans serve Alaskans overall.

In addition, department staff and First Health, Alaska 's Medicaid fiscal agent, helped pharmacies and clients obtain prescription drugs and correct eligibility and plan enrollment during the time the contingency plan was in effect. The department amended the contingency plan to expand allowable state coverage to include assistance for dual-eligible consumers when the benefit plan had an error in the recipient's co-pay amount.

DHSS can still assist with finding the correct plan for the pharmacy to bill at the Recipient Hotline at 1-800-780-9972 or the pharmacy may call the First Health Pharmacy Help Desk to find the correct plan. In the event that a Medicare plan doesn’t cover the client’s prescription needs, dual-eligible Medicaid recipients will need to request that their physician, nurse practitioner or physician assistant file an appeal with the drug plan when their medication is not covered by the plan.