Medicare Part D: The Prescriber's Role
For providers looking for information on Part D plans in Maine, we have a comprehensive list of Formulary Links, Forms and Contacts.
Since 2006, new prescription drug coverage under Medicare has been available to older and disabled people entitled to Medicare Part A or enrolled in Medicare Part B. Medicare Part D benefits are provided by numerous private insurance plans, each of which has its own Formulary, which changes every year and sometimes during the year. These Medicare Part D Plans are required to post their Formularies online. Visit our links to Formularies and forms for many of the Medicare Part D Plans in Maine.
- Patients with Limited Income
If your Medicare patients have limited incomes, they may be entitled to extra help with their prescription costs, through the Medicare Savings Program, the Drugs for the Elderly program or full Maine Care. You could refer them to their local Area Agency on Aging (1-877-353-3771) or their local Department of Health and Human Services office for more information/help applying.
- Prescriber’s Role in Getting Drugs Covered
NOTE: Medicare Part D Plans are not allowed to deny coverage or impose restrictions for drugs in six specific classes, if a person was already stable on the drug when they enrolled in the Medicare Part D Plan. They can require that the generic, rather than the brand name, be used unless the prescriber states that the brand is medically necessary. These classes, referred to as the Six Classes of Clinical Concern, include immunosuppressants (for prophylaxis of organ transplant rejection), antidepressants, antipsychotics, anticonvulsants, antiretrovirals and antineoplastics.
NOTE: Normally, a Medicare Part D Plan has 72 hours to issue a decision on a Coverage Determination. However, if you ask for an Expedited Decision and state that failure to issue an immediate decision will seriously jeopardize the patient’s life or health or their ability to regain maximum function, the Plan must issue a decision within 24 hours.