Frequently Asked Questions

Below are some of the most frequently asked questions we are receiving from our customers.

Can you briefly summarize how this new plan will differ from the current drug benefits in long-term care?

The biggest change will be how drug costs are paid. Approximately 60-70 percent of nursing home residents currently receive prescription drug benefits through the Medicaid Program. Under the new plan, the cost of this benefit will shift to Medicare Part D and the newly formed PDPs and MAs. Whereas one program was providing the benefit, there may now be several PDPs and MAs within each region.

Private pay residents may elect to enroll for the benefits and will be responsible for out of pocket costs such as premiums, deductibles, the doughnut hole, and medication co-payments.

There will be no change for residents on Medicare Part A covered days. They will continue to receive Medicare Part A reimbursement.

Will this new benefit change the relationship between Omnicare and our customers?

No, Omnicare's relationships with our customers will not be affected. CMS has laid out a plan that will require PDPs to demonstrate that they have sufficient contracts with long-term care pharmacies to provide convenient access for residents of long-term care facilities.

CMS has also provided guidance concerning the specific services required for long-term care residents, such as special packaging, routine and emergency delivery and emergency supplies of medications. Omnicare meets or exceeds all CMS requirements.

Are all Medicare residents required to enroll in a drug benefit plan?

For residents who are not dual eligibles, the Medicare Part D drug benefit is optional. However, beneficiaries who do not enroll in Part D during the initial enrollment period and later decide to enroll will pay a 1% penalty for each month that an eligible person delays enrollment unless they have comparable coverage from another source (usually private and group health plans). The enrollment period begins November 15, 2005 and runs through May 15, 2006 for current Medicare beneficiaries.

Dual eligible residents will be randomly assigned to a plan in their region, beginning this fall. Dual eligible residents may elect to enroll in a different Part D plan, but if they do not do so they will be auto-enrolled by CMS into the plan so assigned effective January 1, 2006

How will Medicare Part D coverage differ for individuals living in assisted living facilities?

Although currently the subject of much discussion, assisted living facilities were not included in the initial classification of a long-term care facility, as defined by CMS. Individuals living in a assisted living facility will have access to the same prescription drug benefits as any Medicare-eligible beneficiary. However, they will be responsible for out-of-pocket costs such as the premium, deductible, the doughnut hole, and medication co-payments. This is no special enrollment period for residents of assisted living facilities.