Important information for AHCCCS providers

This new Medicare benefit began on January 1, 2006, and requires every Medicare beneficiary to make a decision. As a trusted source, patients may ask their health care providers for information about the new drug coverage. Because of this, CMS asks the provider community to take advantage of this "teachable moment" to help Medicare patients. Helping can be as simple as referring patients to 1-800-Medicare and www.medicare.gov .

The Centers for Medicare and Medicaid have developed a comprehensive website with information specifically for providers. The site can be found at: http://www.cms.hhs.gov/medlearn/drugcoverage.asp#bene .

Training materials specifically for Health Plans, Regional Health Authorities, and Program Contractors can be found on the AHCCCS website at : http://www.azahcccs.gov/HPlans&Providers/

Basics

• Starting January 1, 2006 Medicare, instead of AHCCCS, began offering new drug coverage to help pay for most of the prescriptions members need. AHCCCS will only pay for members other health care costs.
• Dual-eligible members are automatically eligible for extra help for Medicare premiums and deductibles through the Social Security Administration’s Low Income Subsidy.
• Medicare prescription drug coverage will pay for brand name and generic drugs.
• Medicare will enroll members into a plan with prescription drug coverage, based on their current enrollment status with AHCCCS.

Frequently Asked Questions
For a complete list of Frequently Asked Questions asked by AHCCCS members, visit the Members Page.
 

Part D Drug Plans Available in the State of Arizona
Although all Part D Drug Plans must be approved by CMS, not all plans are the same:

• Each plan has the flexibility to decide which prescription drugs it will cover (called the formulary), as long as they cover at least one generic and one brand name drug within each class of covered drugs.
• Some plans will have lower or higher premiums, deductibles and co-payments than other plans. Some plans may waive the coverage gap.
• Each plan will contract with certain pharmacies
• Each plan will negotiate an allowable cost for prescription drugs with their network of providers.

There are also different types of plans: PDPs, MA-PDs and SNPs

Prescription Drug Plans (PDP)

A PDP is a stand-alone Medicare Part D Prescription Drug Plan. These plans must offer services statewide and will be available to the people with Medicare who are not enrolled with a MA-PD or a SNP. These are the PDPs available in Arizona as of 11/15/05:

• ADVANTAGE Rx
• AETNA LIFE INSURANCE COMPANY
• CIGNA
• COVENTRY HEALTH AND LIFE INSURANCE COMPANY
• FOX INSURANCE COMPANY
• HEALTH NET
• HUMANA INC.
• MEDCO/YOURx PLAN
• MEMBERHEALTH, INC/COMMUNITYCARE Rx
• PACIFICARE LIFE AND HEALTH INSURANCE COMPANY
• PRESCRIPTION PATHWAY
• RxAMERICA, LLC
• SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC
• SILVERSCRIPT INSURANCE COMPANY
• STERLING LIFE INSURANCE COMPANY
• UNICARE
• UNITED AMERICAN INSURANCE COMPANY
• UNITED HEALTH CARE
• WELLCARE HEALTH PLANS

Only five of the PDPs have premiums which are equal to or less than the Extra Help premium subsidy of $24.62. These are also the plans into which CMS will be auto-enrolling the dual eligible population who are not enrolled with a MA-PD or SNP. The 5 auto-enrollment PDPs as of 11/15/05 are:

• HEALTH NET LIFE INS CO/HEALTH NET INS OF NY
• HUMANA INSURANCE COMPANY
• SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.
• UNICARE
• UNITED HEALTH CARE INSURANCE COMPANY

Medicare Advantage Prescription Drug Plans (MA-PDs)

A MA-PD is a Medicare Advantage-Prescription Drug plan. Effective January 2006, Medicare Plus or Choice plans will be called Medicare Advantage plans. MA plans are not required to, but may also provide Part D prescription drug coverage. If they do, the Medicare Advantage plan will be a MA-PD. These plans will be available to people with Medicare who are enrolled with the Medicare Advantage plan. Persons who are currently enrolled with a Medicare Advantage plan that will provide Part D benefits will be auto enrolled with those plans. The MA-PDs in Arizona as of 11/15/05 are:

• ABRAZO ADVANTAGE HEALTH PLAN (PHOENIX HEALTH PLAN)
• AETNA
• ARIZONA PHYSICIANS IPA
• CARE1ST HEALTH PLAN OF ARIZONA
• CIGNA
• DESERT CANYON COMMUNITY
• HEALTH CHOICE
• HEALTH NET
• HUMANA
• MERCY CARE
• SECURE HORIZONS
• SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.
• SUN HEALTH MEDISUN, INC.
• UNITED HEALTHCARE

Special Needs Drug Plans

A SNP is a Medicare Special Needs Plan. These plans are limited to persons with special needs:

• Persons with chronic illnesses,
• Persons residing in nursing facilities, or
• Dual eligibles.

The MA-PD plans in bold type on the list above also have a Medicare Special Need Plan.

Some AHCCCS health plans have become Medicare Special Needs Plans that are only to enroll dual eligibles. About half of the dual eligibles are enrolled with these plans. These people may get their Medicaid, Medicare and Part D prescription drug services all from the same health plan. The AHCCCS Plans that are Medicare SNPs as of 11/15/05 are:

• APIPA PERSONAL CARE PLUS – Cochise, Maricopa, Mohave, Pima and Yuma counties
• ONE CARE BY CARE 1ST HEALTH PLAN OF ARIZONA –Maricopa county
• EVERCARE, THROUGH UNITED HEALTH CARE, OFFERS EVERCARE PREMIER AND EVERCARE PLAN IN MARICOPA AND PIMA COUNTIES AND EVERCARE CHOICE IN MARICOPA, PIMA AND PINAL COUNTIES
• MERCY CARE PLAN
• PHOENIX HEALTH/COMMUNITY CONNECTION
• HEALTH CHOICE ARIZONA

If your clients/patients need assistance with this benefit, please refer them to 1-800-Medicare or the "Resources" page for additional online help and information.

If you have additional questions, the "Resources" page and 1-800-Medicare have useful information or you can call the AHCCCS Provider Relations Unit at 602-417-4072.

Medicare Prescription Drug Coverage Home Page