Changes in Medicaid Pharmacy Coverage

The Department of Social Services (DSS) recently announced important changes to the Medicaid Pharmacy coverage for some individuals served by the Department of Developmental Services (DDS). These DDS individuals are not only receiving Medicaid Pharmacy coverage but are also enrolled in Medicare Part D.

You may have also recently received a blue or tan letter from Medicare regarding changes to your Medicare Part D Plan for the 2010 benefit year. If you received one of these letters, please see below for additional information.

If you received a TAN letter:

  • In the past, you chose and enrolled in a benchmark plan on your own; however, your plan’s premium is changing in 2010, and you will have to pay a portion of the monthly premium unless you join a new plan by December 31, 2009.
  • You have two choices:
    • Continue to stay in your current plan and starting in January 2010, pay the difference in premium after Medicare pays their portion, OR;
    • You can choose to move yourself into one of the 13 benchmark plans that are offered for the 2010 benefit year and have no premium responsibility.
    • Medicare will NOT reassign you to a new plan; it will be your responsibility.
    • If you choose to change plans, you can contact Medicare or CHOICES for assistance:
      • Medicare at 1-800-633-4227
      • Connecticut CHOICES program at: 1-800-994-9422.

      If you received a BLUE letter, it can mean one of two things:

      • Currently, you are in a benchmark plan that Medicare originally assigned you to, however, that plan’s premium is increasing in 2010, making it a non-benchmark plan, OR;
      • Currently, you are in a benchmark plan that Medicare originally assigned to you, however, that plan is leaving the Medicare program and will no longer be offered for the 2010 benefit year.
      • You have two choices:
        • Choose your own benchmark plan from the list of 13 plans by December 31, 2009, OR;
          • Medicare will re-assign you to one of the 13 benchmark plans effective January 1, 2010.
        • If you want to choose your own plan for 2010, you can contact CHOICES or Medicare for assistance:
          • Medicare at 1-800-633-4227
          • Connecticut CHOICES program at: 1-800-994-9422

          What will the costs be?

          • Currently, all prescription co-pays and premiums are paid for by Medicaid.
          • Starting January 1, 2010, individuals will be responsible for up to $15 in Part D co-pays per month, no matter how many prescriptions you require. You may be responsible for less than this each month, but the maximum you will have to pay in Medicare Part D co-pays each month will be $15.00.
          • It is important to remember that pharmacies are not obligated to provide your prescription without collecting the necessary co-payment.
          • Starting January 1, 2010, Medicaid will NO longer pay for non-formulary medications; that is, drugs not on your individual Medicare Part D Plan’s formulary (approved drug list). Medicaid will, however, continue to cover Medicare Part D excluded drugs such as benzodiazepines and barbiturates.
          • Please understand that Medicaid will NO longer pay the monthly premiums for non-benchmark Medicare Part D plans beginning January 1, 2010.
        • Letter from Department of Social Services