New drug plan faces transition challenge

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The Medicare Part D program faces more possible criticism following the expiration of the 90-day transitional period on April 1.

Advocates are preparing for potential aftershocks, particularly from the dual eligible community, or those who are eligible for Medicare and Medicaid. The end of the transition period means that plans must no longer cover medications they were required to offer during the emergency period. Dual eligibles may not be aware the change in coverage. There is also a lack of a standardized form to appeal coverage decisions, advocates say.

Health plans originally agreed to offer 30 days of emergency coverage but then extended the period to 90 days to help beneficiaries find generic substitutions, request exceptions from their insurer or switch plans. During the emergency period health plans had to provide medication that beneficiaries were receiving before the start of Medicare Part D. At press time, neither the government nor the plans had unveiled plans for ongoing coverage.