What to Know About Part D for 2016

Posted Dec. 3, 2015

Key Changes for Pharmacists and Their Patients

By Sonya Collins, MA, MFA, Excerpt from American Pharmacists Association

Reprinted from Elevate Provider Network


Open enrollment for Medicare Part D begins on October 15, 2015, and ends on December 7, 2015. CMS has released revisions to Part D that will take effect in 2016. Changes include added emphasis on medication therapy management (MTM) and post discharge medication reconciliation, steps to improve access to services and information, and increased discounts on generic drugs.


What should pharmacists tell their patients?

Medicare prescription drug plan premiums will remain stable at about $32.50 per month, up from $32 in 2015. But premiums for specific plans and regions vary from year to year. "It's important for Medicare beneficiaries to examine their annual notice of change (ANOC) carefully to determine if and how their plan's costs or benefits are changing and if it makes financial sense to explore other options," said Mitchell Clark, a spokesperson for the Medicare Rights Center.


In 2016, beneficiaries will continue to get a 55% discount on brand-name drugs during the coverage gap. The discount on generic drugs will increase from 35% to 42%. Pharmacists should advise patients, however, that covered drugs and related restrictions can change from year to year.


"Drugs and restrictions can be removed or added. It is important that a person checks their current plan's new formulary to see how the drugs they take will be affected," Clark said.


Beneficiaries should review their ANOC and the summary of the new formulary in particular to make sure their prescriptions are still on the list. People who want to change plans should make sure the plans they are considering cover their prescriptions. If the summary of the new formulary does not include a beneficiary's prescriptions, patients may find the full formulary online or call the plan to request it. 


Pharmacists can direct patients who are shopping for a new plan to Medicare's online plan finder tool (www.medicare.gov/find-a-plan). After patients gather all the information they need about a plan, pharmacists should advise patients to call the plan to confirm the information they found online.


"This will help avoid making a decision based on inaccurate information," Clark said.


Discourage patients from choosing a plan based on price alone, he added. "They should check to see if the plan they are considering covers all their medications, and whether any special permissions, such as prior authorization, step therapy or quantity limits, are required."