Currently, Medicare Advantage (MA) beneficiaries with at least $4,000 worth of annual drug costs are eligible for pharmacy consultations at no cost. These consultations are provided to ensure: 1) people understand how to use their medication, and 2) the medication prescribed will not produce adverse side-effects with other medications the person may be taking.
In 2010, new guidelines from the Center for Medicare and Medicaid Services (CMS) will broaden the pharmacy consultation benefit to more MA beneficiaries. Health plans will be prohibited from restricting access to the benefit to members with a high number of chronic health conditions and medications, and the annual drug cost limit will be reduced from $4,000 to $3,000. Also, under the revised guidelines, MA plans will be required to review their member rolls on a quarterly basis to identify eligible members for the program.
Pharmacists will be paid $50 by the health plans to review a beneficiary’s medications and make recommendations to their physician. Pharmacists will receive additional payments if they recommend a less-costly, therapeutic equivalent to the patient. This may be an important step, both in reducing health care costs and in improving people’s overall health as less medications reduce side effects and harmful interactions between medications.
For information on Medicare’s Part D drug coverage, see: