The Centers for Medicare and Medicaid Services (CMS) has established protections for Medicare Part D beneficiaries when they experience coverage transitions. To assist advocates with transition issues, Justice in Aging has released a paper that sets out the CMS minimum requirements for all plans.
Beneficiaries in Medicare Part D drug plans can experience gaps in coverage of their prescriptions for a number of reasons:
- When they move to a new plan, either voluntarily or automatically
- When they first enroll in Part D
- When their plan drops coverage of the drug they are taking or imposes utilization controls
- When they move from one level of care to another
CMS requires plans to provide transition supplies of drugs and written notification explaining rights and procedures for requesting exceptions.
This tool for advocates details beneficiary rights under various scenarios and outlines plan responsibilities required by CMS.