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ARLINGTON, Va. — The Centers for Medicare and Medicaid Services is encouraging health plans to cover patients' existing non-formulary drugs as though they were formulary drugs for the first 30 days after the Jan. 1 rollout of the insurance coverage provided under the Patient Protection and Affordable Care Act.
CMS also is recommending that plans treat out-of-network providers as in-network providers during the initial months of enrollment to address situations in which out-of-network providers were listed as in-network at the time of enrollment or are providing treatments for acute episodes of care at the start of the year.
The recommendations have drawn support from the National Association of Chain Drug Stores, a trade group of retail pharmacy chains, which is hoping that CMS includes pharmacies as part of the recommendations.
"We welcome the additional millions of Americans who will have new insurance coverage," a letter from the NACDS to the CMS read. "We are committed to working with all parties to address challenges and to maximize the experience of patients, similar to the efforts of community pharmacy that were noted as vital to smoothing the transition during the rollout of Medicare Part D."
The group also is recommending that CMS "empower patients with information" so that they can maximize their experience with healthcare reform.
"We are concerned that the initial enrollment deadline extensions may result in some newly insured patients not having the information necessary to process pharmacy claims for them in January," the NACDS' letter read. "We are also concerned that some patients who enroll in a plan and take the opportunity to pay January premiums later in January may not be aware that they must pay for their health care and prescription drug services out-of-pocket pending payment of their insurance premium. In light of our concerns, NACDS urges CMS and insurers to engage in consumer education and outreach to address and mitigate these scenarios, offer ample support for pharmacies via call centers throughout the holidays and use techniques that helped to ease the transition for the initial enrollment in Medicare Part D."