Medicare Part D Prescription Drug Plan Contracts Coming
5-27-05
The Medicare Part D Prescription Drug Plans are in the process
of sending contracts to IHS, Tribal and Urban (I/T/U) pharmacies.
These contracts will be necessary for pharmacies to continue receiving
maximum reimbursement for dispensing prescription drugs to dual
eligibles (enrolled in both Medicare and Medicaid) after January
1, 2006. Contracts from each Medicare Part D Plan should be carefully
reviewed by contracting officials, tribal staff and/or Tribal legal
counsel before they are signed and returned. Because the 2006 Part
D Plans and their premiums will not be known until September 2005,
some Tribal governments may want to negotiate pharmacy contracts
with all plans to ensure contracts are in place for $0 premium Part
D plans.
Please be aware that Dr. Charles Grim, IHS Director sent a letter
out on May 4, 2005 with more information about Medicare Part
D Prescription Drug Plans to your Tribal Leaders and your Chief
Pharmacists. Please help circulate this information to the proper
staff at your Tribal government.
In particular, Tribal governments should remember to note the following
areas:
- Reimbursement Rates - Each Part D Plan may offer different pharmacy reimbursement rates. CMS was unwilling to direct Part D Plans to pay Tribes the same Medicaid rates that Tribes are currently receiving. Reimbursement rates less than current Medicaid rates will result in a decrease of Tribal pharmacy revenue.
- Tribal Indian Health Addendum - Through the CMS TTAG, Tribal advisors have negotiated special language that should appear in all Part D contracts offered to Tribes. This language may appear as an addendum to the contract or may be inserted into the contract itself. A copy of this special Tribal addendum is available online at: both the www.aianmedicare.org and www.cmsttag.org websites. Under CMS policies, Tribes have the right to insist that this language be part of their contracts with all Part D plans.
- Tribal Sovereignty - Some Tribes have received contracts with language that may have the effect, in limited situations, of waiving Tribal sovereignty. Please review contracts carefully to be sure they do not include language that may potentially undermine your Tribe's legal standing or policies. If you receive a contract that includes language waiving sovereignty or sovereign immunity, please report this to your area IHS or CMS office or Headquarters.
- Because each contract will be different, it's important to also be sure your pharmacy and tribe can meet the other conditions of the contract. Tribes are being encouraged to work together in their contract reviews and Plan negotiations.
It is also important to note that the contracting official should contract the plan in writing noting receipt of the contract and a time frame by which the plan can expect to hear back from the contracting official. The Tribe or Urban Program will have 45 days from the date of receipt of the contract to sign, negotiate changes or reject the contract. It is recommended that if the Tribal or Urban health program expects the review process will take more than 45 days, they immediately contact the plan in writing and request a written extension. Plans may grant additional time, but are not required to do so. If a plan's contract does not contain all of the provisions of the Tribal or Urban Indian Program addendum or if the Tribal or Urban Indian Program addendum items have been modified to change the intent, the Tribal or Urban Indian program should notify the IHS identifying the specific plan and the issue. Please do not sign and return the contracts unless you have had time to review them. Also, please contact CAPT Robert Pittman at (301) 443-1190 or by E-mail at robert.pittman@ihs.gov if you find that the Tribal or Urban Indian addendum has been altered. IHS has already heard of plans with the following problems:
- Including the IHS and Tribal Addendum issues together in one contract. This is fine if there is a way, such as a check mark to identify which provisions apply to the specific contract your site is signing.
- Contracts or agreement that do not include the addendum or have the addendum issues addressed in the contract.
- Contracts without a reimbursement section (sites don't know how much they will be reimbursed).
- Plans that require a response in less than 45 days (CMS expects plans to give I/T/Us at least 45 days).
- Language threatening to exclude the pharmacy from all of the network's business unless the pharmacy signs for that plan's Medicare Prescription Drug Coverage.