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 Understanding the Relationship Between Medicare Part B and Part D: Coverage and Reimbursement for Prescription Drugs, Related Items and Pharmacy Services
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Program Description
Prescription drugs are covered under Medicare Parts A, B, and D. Of particular concern to the community retail pharmacy is how existing coverage of Medicare Part B drugs, some of which are provided by pharmacies, will be affected by the new Medicare Part D prescription drug benefit, which begins in January 2006. Both Parts B and D will cover oral, inhalation, injectable and infusion drugs, and the retail pharmacist will have to know which program to bill when receiving a prescription for these various drug products. Medicare Part B also pays pharmacies under a new reimbursement system based on average sales price, while Medicare Part D will rely on the negotiating capabilities of pharmacies to determine reimbursement. This program will review the coverage, reimbursement and billing rules for drugs covered under Medicare Parts B and D and help the pharmacist to understand each program's rules.


Faculty Information
Steven Stranne, M.D., J.D. is a partner in the Washington, D.C. office of the law firm Powell Goldstein LLP, and he is also an active member of an affiliated health policy research group, HealthPolicy R&D. Dr. Stranne focuses his practice on developing and implementing regulatory, legislative and strategic initiatives for health care manufacturers, associations, providers and patient groups, as well as conducting health care policy research. He received his M.D. from Duke University School of Medicine and his J.D. from Harvard Law School.


Faculty Disclosure
The NACDS Foundation has a conflict of interest policy that requires course faculty to disclose any real or apparent commercial financial affiliations related to the content of their presentations and materials. The author of this program has no conflict of interest.


Disclaimer
The author, sponsor and publisher of this continuing education program all have made reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available knowledge at the time of accreditation of this continuing education program. Information regarding the implementation of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (the Medicare Modernization Act or MMA) is subject to change, and the reader is advised to check the Centers for Medicare and Medicaid Services’ (CMS’) website on MMA implementation,
http://www.cms.hhs.gov/medicarereform/pdbma.general.asp
, for the latest information


Course Objectives
At the conclusion of this program, participants should be able to:
  1. Describe the scope of coverage of outpatient prescription drugs under the Medicare program, including the differences between Part B and Part D;
  2. Describe the reimbursement policies governing outpatient prescription drugs that are covered under Medicare, including the differences between Part B and Part D; and
  3. Identify categories of prescription drugs that may be covered under both Medicare Parts B and D, depending upon the circumstances, and describe the general rules regarding when coverage will exist under one benefit versus the other.

Target Audience
This program is appropriate for pharmacists and pharmacy technicians. This program is not intended for Medicare beneficiaries.

Course Category This activity has been designated as Knowledge-Based
Technologies Used

Adobe Acrobat Reader Adobe Acrobat Reader
Monograph Monograph

Price: FREE!
ACPE Accreditation
The National Association of Chain Drug Stores (NACDS) Foundation is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

This home study web activity has been assigned a maximum of 2 credit hours (0.2 CEU) and the ACPE UPN: 206-000-05-507-H03.

Expiration Date: 07/01/2008

Release Date: 07/11/2005

 
To receive educational credit, participants must pass the online assessment with a score of 70% or better. If you do not receive a minimum score of 70% or better, you are permitted to retake the test. After passing the assessment, you can view, print and track your statements of credit online. There is no fee to participate in this activity.

The material presented here does not reflect the views of Pharmacy Choice, Inc., RxSchool, or the companies providing educational content. These materials may discuss uses and dosages for therapeutic products, processes, procedures and inferred diagnoses that have not been approved by the United States Food and Drug Administration. A qualified health care professional should be consulted before using any therapeutic product discussed. All readers and continuing education participants should verify all information and data before treating patients or employing any therapies described in this continuing education activity.





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