Final - Low Income Toolkit 0106

Auto-Assigned, Low Income Dual Eligible Beneficiaries –

Florida State Communication Tool Kit

January 2006 FINAL –1/3/2006 Background Beginning January 1, 2006, Medicare beneficiaries who are also eligible for Medicaid benefits, referred to as “dual eligibles,” will begin receiving their primary prescription drug coverage through the new Medicare prescription drug program, instead of their state’s Medicaid program. Because this population generally has more complex health conditions and use more prescription drugs than other Medicare beneficiaries, full-benefit dual eligibles were automatically assigned to a qualifying prescription drug plan, chosen at random by Medicare, to ensure they do not experience any disruption as their coverage transitions from Medicaid to Medicare. Dual eligibles were informed by the Center for Medicare and Medicaid Services (CMS) about the prescription drug plan to which they were assigned in November. For many dual eligibles, the plan to which they were assigned will best meet their prescription drug needs, but like all people with Medicare they have the right to choose their own drug plan. Therefore, it is important that dual eligibles receive accurate, clear and meaningful information about other Medicare prescription drug plans available to them in their state. To that end, several states worked with an external vendor to develop letters to inform dual eligibles of alternative Medicare prescription drug plans that would best meet their needs. The letters, sent in December, do so by matching the medications and pharmacies they have recently used with those offered by a particular plan, enabling beneficiaries to make a comparison. UnitedHealth Group shares an interest with states to ensure all Medicare beneficiaries have access to accurate and helpful information about their Medicare prescription drug plan options. That is why we have worked with the federal government, state Medicaid offices and plan providers to ensure these important letters are clear and that the data the vendor used to develop them accurately reflects plans’ offerings. These key messages and Q&A are designed to support spokespeople engaged in discussions in explaining what Part D means for dual eligibles and how UnitedHealth Group is working with federal and state officials, as well as private businesses to ensure the information needed to guarantee their smooth transition to Part D is clear and accurate, and does not foster confusion. The intended audience for this material is three-fold: Media, key influencers and consumers (in general). Specific pieces are marked according to their intended audience.

Auto-Assigned, Low Income Dual Eligible Beneficiaries Florida State – Communication Tool Kit

Final – January 3, 2005

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Key Messages – Media (Not for External Distribution) Medicare’s new prescription drug benefit will help bridge a major gap in American healthcare and provide a much-needed safety net, especially for dual eligible beneficiaries. • Approximately 6 million Americans are fully dual eligible for Medicare and Medicaid. They

receive health care benefits both from the federal government and from their state Medicaid program.

• As of January 1, their primary pharmacy coverage is through a Medicare prescription drug plan. In addition to Medicare Part D, most states will provide dual eligibles with “wrap-around” benefits for specific drugs not covered by Medicare, or to cover the cost of Part D drug plan co-payments.

• Dual eligibles generally have more complex health needs than other Medicare beneficiaries and use multiple prescription drugs.

• Those with multiple prescriptions, several chronic diseases, and high annual drug expenses can participate in special medication therapy management consultations geared to help prevent adverse drug reactions ensure the best results.

UnitedHealth Group is working hard to bring high-quality, affordable drug coverage to all Americans, including the millions of dual eligible beneficiaries. We are pleased to be working with the federal government, state Medicaid offices and plan providers to guarantee dual eligibles enjoy a smooth transition to the Medicare prescription drug benefit. This is consistent with our mission to bridge gaps in the health care system. • UnitedHealth Group made the decision to offer the benefit based on our long-standing

commitment to the millions of older Americans we serve, and we appreciate this opportunity to assist those who need help in combating the high costs of prescription drugs.

• We are using our long experience with Medicare to offer a prescription drug plan that is affordable, simple in design, and offers the high quality that consumers deserve.

• Ovations, the business unit of UnitedHealth Group that operating the Medicare Prescription Drug plan, is the largest and most recognized business dedicated to the senior market, serving more than five million older Americans. We offer prescription drug coverage in all 50 states. In fact, we insure 50% of those beneficiaries with prescription drug coverage.

• Ovations has a strong history of working on behalf of older Americans to deliver high- quality, affordable prescription drug programs. Offering this benefit is consistent with our mission to bridge the gaps in the healthcare system and offer older Americans broad benefits and services tailored to their individual needs.



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The federal government, state Medicaid offices and plan providers are collaborating closely to ensure a safe, smooth and appropriate transition of the dual eligible population from Medicaid to Medicare prescription drug coverage. • CMS recently outlined its key objectives to delivering on the promise of making the

transition from Medicaid to Medicare prescription drug coverage seamless and efficient.

• All plan providers must have Medicare-approved Part D transition plans in place that anticipate potential issues and support a seamless implementation.

• State programs are sending their enrollees information to explain how drug coverage will be coordinated between Medicare and Medicaid.

• If a beneficiary visits a pharmacy and demonstrates that they are Medicaid and Medicare eligible, but not yet enrolled in a Part D plan, Medicare has created a system where the beneficiary can leave the pharmacy with their prescriptions and a drug plan provider. The plan provider will immediately follow up to validate eligibility and facilitate enrollment into a Part D plan.

Dual eligibles have the right to choose their own drug plan. For many, the plan to which they were assigned will best meet their prescription drug needs. However, it is important that dual eligibles receive information about other Medicare prescription drug plans available to them in their state. Several states are working to develop letters that will help dual eligibles determine which Medicare prescription drug plan best meets their needs. • For many dual eligibles the plan to which they were assigned will best meet their prescription

drug needs, but like all people with Medicare they have the right to choose their own drug plan. Therefore, it is important that dual eligibles receive accurate, clear and meaningful information about other Medicare prescription drug plans available to them in their state.

• UnitedHealth Group shares an interest with states to ensure all Medicare beneficiaries have access to accurate and helpful information about their Medicare prescription drug plan options.

• Several states have been working with a outside vendor to develop letters to inform dual eligibles of alternative Medicare prescription drug plans that would best meet their needs should they choose to switch.

• The letters, sent by the state of Florida, do so by matching the medications and pharmacies they have recently used with those offered by a particular plan, enabling beneficiaries to make a comparison.

• UnitedHealth Group worked with the federal government, state Medicaid offices and plan providers to ensure the data used to develop this important letter accurately reflects plans’ offerings.



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UnitedHealth Group is working with advocacy groups, community organizations and the states to support dual eligibles as they make a smooth transition from Medicaid to Medicare prescription drug coverage. • UnitedHealth Group has been nationally recognized as Part D innovator and leader, both for

its range of prescription drug plans and for its Part D consumer education programs.

• More than 500,000 dual eligibles have already been auto-assigned to Part D plans offered by UnitedHealth Group.

• We are collaborating with several groups to help auto-assigned dual eligibles and their caregivers learn what Part D means for them.

• We have created an easy-to-use resource guide specifically tailored for dual eligibles who have been auto-assigned.

• It’s essential that all beneficiaries have the tools and information they need to get the most from their prescription drug coverage, and we’re proud to be helping in this national outreach effort.

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Potential Q&A – Media (Not for External Distribution)

Q1. What % of dual eligibles does UnitedHealth Group have in its plans?

There are approximately 6.3 million full benefit dual eligible beneficiaries in the U.S. today. They were automatically assigned to a qualifying prescription drug plan, chosen at random by Medicare, to ensure they do not experience any disruption as their coverage transitions from Medicaid to Medicare. UnitedHealth Group was assigned just over 580,000 across the nation and 54,254 in the state of Florida. They have the right to switch to another plan and we fully support this freedom of choice.

Q2. Why are dual eligible beneficiaries being assigned a drug plan?

Dual eligibles generally have more complex health conditions than other Medicare beneficiaries and use more prescription drugs. Beginning January 1, 2006, full benefit dual eligibles will begin receiving their primary prescription drug coverage through the new Medicare prescription drug program, instead of their state’s Medicaid program. They were automatically assigned to a drug plan to ensure they would experience no interruption in coverage during the Part D transition.

Q3. What are you doing to ensure dual eligible individuals understand how Part D applies to

them?

UnitedHealth Group has been nationally recognized as Part D innovator and leader, both for our customer-centered drug plans and for our Part D education programs. We are working with advocacy groups, community organizations, physicians, pharmacists, nursing administrators and other providers, CMS and the states to help auto-assigned dual eligibles and their caregivers learn what Part D means for them. We have created an easy-to-use resource guide specifically tailored for people who have been auto-assigned, along with Q&As and other materials that are being used as part of our ongoing national outreach campaign.

Q4. How were duals assigned to, and informed of, their plan assignment?

Dual eligibles were randomly assigned a plan in October by Medicare and received a letter with their plan assignment. Plans are providing additional information to their enrollees, including details about using the plan and how drugs are covered.

Q5. Can enrollees choose a different prescription drug plan?

Yes. All people with Medicare, including those who were auto-assigned, have the right to choose their own drug plan. Dual eligibles can change drug plans throughout the year, up to once a month, as long as they are receiving Medicare and Medicaid. If an enrollee wants to keep their assigned plan, there is nothing they need to do.



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Q6. Why was it necessary for UnitedHealth Group to work on a letter coming from the state to dual eligibles – was there something wrong with the letters?

UnitedHealth Group shares an interest with the state and federal governments to ensure all Medicare beneficiaries have access to accurate and helpful information about their Medicare prescription drug plan options. That is why we along with several other health plan providers worked with the federal government and state Medicaid offices to ensure these important letters are clear and that the data used to develop them accurately reflects plans’ offerings.

Q7. What is being done to ensure that dual eligibles’ transition to Medicare Part D goes

smoothly?

The Federal government has taken numerous steps, working with state governments and plan providers to ensure dual eligibles – who are often vulnerable from a health as well as financial standpoints – do not experience interruption in their prescription drug coverage: • CMS recently outlined its key objectives to delivering on the promise of making the transition

from Medicaid to Medicare prescription drug coverage seamless and efficient.




Q8. How is UnitedHealth Group specifically helping their assigned dual eligibles through the

transition? Our Part D plans were built with the needs of dual eligibles in mind and are designed to mitigate any disruption in their prescription drug coverage. Our list of drugs exceeds federal recommendations and includes virtually every drug covered under Part D, including thousands of brand name and generic medications. We have responsive exception procedures that provide access as needed to brand name versions of generic drugs, if the branded drug is required. For the very small number of drugs where plan authorization is required before a prescription is filled — just 46 out of our entire formulary — enrollees can receive a five-day emergency supply while coverage determination is being made. Our extensive pharmacy network includes more than 50,000 retail stores across the country, optional mail order services, long-term care pharmacies, and specialty and community pharmacies, providing convenient access for enrollees.

Q9. What happens to dual eligibles whose assigned plans do not cover all their drugs?

All plans must fill all dual eligibles’ prescriptions for one month, even if the drug is not covered. In addition, all plan providers are required to have Medicare-approved Part D transition plans in place that anticipate potential issues and support a seamless implementation. Our transition plan is tied to



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our formulary and benefit structure and will give all new enrollees access to virtually all medication entities covered under Part D. Key features:

• Formulary exceeds federal recommendations, includes virtually every drug covered under Part D, including thousands of brand name and generic medications; specially tailored to population.

• For drugs not covered, we’ll work with enrollees (and their physicians) to find other covered drugs that are equal to their current medication; we have responsive exception procedures that provide access as needed to brand name versions of generic drugs, if the branded drug is required.

• Five-day emergency supply for very small number of drugs (just 46 out of our entire formulary) where plan authorization or step therapy required while coverage determination being made.

• Extensive pharmacy network of more than 50,000 retail stores nationwide, mail order services, long-term care pharmacies, and specialty and community pharmacies, provides convenient access.

Also, CMS requires all plans to offer those with multiple prescriptions, several chronic diseases, and high annual drug expenses special medication therapy management consultations geared to help prevent adverse drug reactions ensure the best results.

Finally, many states will provide dual eligibles with “wrap-around” benefits for specific drugs not covered by Medicare, or to cover the cost of Part D drug plan co-payments. In fact, for dual eligibles, CMS requires that in each state Medicare Part D continue to cover all drugs currently covered by that state’s Medicaid program even if it falls into the limited categories of drugs not covered by Part D, such as benzodiazapenes.

Q10. How is UnitedHealth Group participating in Part D?

We are offering a broad range of Part D plans across the country and in the U.S. territories, including integrated Medicare Advantage plans with built-in drug coverage (MA-PDs), stand-alone prescription drug plans under the AARP and UnitedHealthcare brands (PDPs), and dual eligible and Institutional Special Needs Plans.

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Key Messages – Key Influencers (To be used with and by Physicians, Pharmacists and Community-based Groups) Medicare’s Part D prescription drug plans will help bridge a major gap in American healthcare and provide a much-needed safety net, especially for dual eligible beneficiaries.

• Approximately 6 million Americans are fully dual eligible for Medicare and Medicaid. They receive health care benefits both from the federal government and from their state Medicaid program.

• Today, dual eligibles have their drug coverage through Medicaid. Starting January 1, 2006, they will receive their primary pharmacy coverage through a Medicare prescription drug plan.

• In addition to Part D, most states will provide dual eligibles with “wrap-around” benefits for specific drugs not covered by Medicare, or to cover the cost of Part D drug plan co-payments.

• Dual eligibles generally have more complex health needs than other Medicare beneficiaries and use multiple prescription drugs. That’s why it is especially important to mitigate any disruption in their drug coverage during the Part D transition.

The vast majority of dual eligibles have already been enrolled in a Part D plan, with the goal of making Part D a smooth, well-coordinated event.

• To ensure that they have continuous drug coverage, dual eligibles were randomly assigned by Medicare to a drug plan in their area and notified of that assignment in October.

• Medicare providers are proactively contacting enrollees with details about using their plan and how drugs are covered.

• If an enrollee wants to keep their assigned plan, there is nothing they need to do.

• All people with Medicare, including those who were auto-assigned, do have the right to choose their own drug plan.

• Dual eligibles can change drug plans throughout the year, up to once a month, as long as they are receiving Medicare and Medicaid.

Medicare’s prescription drug plans reflect the unique needs of dual eligible beneficiaries.

• Dual eligibles have no premiums for their Medicare drug plans, no deductibles or coverage gaps, and pay very little or nothing at all for almost all prescriptions.

• The most a dual eligible will pay at the pharmacy is $5 for each medication, each time the prescription is filled.

• Full dual eligibles who live in nursing homes are completely subsidized by Medicare and pay nothing out of pocket for their drug coverage.



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• If a drug is not covered, plans will work with enrollees and their physicians to find other covered drugs that are equal to a member’s current medication, helping to maximize their Medicare drug coverage.

• Medicare drug plans have extensive pharmacy networks and offer valuable consumer education, including up-front drug safety checks to ensure their medications are safe and appropriate.

• Plan enrollees can participate in medication therapy management consultations. In these one-on-one meetings, pharmacists will review all of an enrollee’s current medications, explain how they work, and confirm how to take those medications for the best results.

The federal government, state Medicaid offices and plan providers are collaborating closely to make Part D successful.



• Individual states are helping dual eligible and low income beneficiaries determine which drug plan best fits their needs. For example, in Florida these beneficiaries are receiving a letter that lists available drug plans in the state and matches the medications and pharmacies beneficiaries use with those offered by the plans.


UnitedHealth Group’s Part D plans were built with the needs of dual eligibles in mind and are designed to mitigate any disruption in their prescription drug coverage.

• Our list of drugs exceeds federal recommendations and includes virtually every drug covered under Part D, including thousands of brand name and generic medications.

• We have responsive exception procedures that provide access as needed to brand name versions of generic drugs, if the branded drug is required.

• For the very small number of drugs where plan authorization is required before a prescription is filled — just 46 out of our entire formulary — enrollees can receive a 5 day emergency supply while coverage determination is being made. Expedited requests take no more than 24 hours, and standard requests are no more than 72 hours.

• Our extensive pharmacy network includes more than 50,000 retail stores across the country, optional mail order services, long-term care pharmacies, and specialty and community pharmacies.



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Additionally, UnitedHealth Group is working with advocacy groups, community organizations and the states to support auto-assigned dual eligibles during the Part D transition.

• UnitedHealth Group has been nationally recognized as Part D innovator and leader, both for its range of prescription drug plans and for its Part D consumer education programs.

• More than 500,000 dual eligibles have already been auto-assigned to Part D plans offered by UnitedHealth Group.

• We are collaborating with several groups to help auto-assigned dual eligibles and their caregivers learn what Part D means for them.

• We have created an easy-to-use resource guide specifically tailored for dual eligibles who have been auto-assigned.

• It’s essential that all beneficiaries have the tools and information they need to get the most from their prescription drug coverage, and we’re proud to be helping in this national outreach effort.

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Potential Q&A – Key Influencers

Q1. What is the Medicare prescription drug program? This federally-funded, privately administered program was created as part of the Medicare Modernization Act of 2003. It is designed to lower out-of-pocket prescription drug costs and expands access to safe, affordable medications for millions of underinsured Americans.

Q2. Why is Medicare Part D important?

Medicare’s new prescription drug plans will help bridge a major gap in American healthcare and provide a much-needed safety net, especially for beneficiaries who use multiple prescription drugs.

Q3. What does it mean for people who have Medicare and Medicaid?

Approximately 6 million Americans are fully dual eligible and receive health care benefits from both Medicare and Medicaid. Today, dual eligibles have their drug coverage through Medicaid. Starting January 1, 2006, they will receive their primary pharmacy coverage through a Medicare prescription drug plan.

Q4. When does the Medicare drug program begin?

The new Medicare prescription drug plans begin January 1, 2006 for people who enroll by December 31, 2005. On that date, dual eligibles are covered under Medicare for most of their prescription drugs.

Q5. Will Medicaid cover any medications for dual eligibles, once their Medicare plan

starts? Most states will offer some limited “wrap-around” coverage for specific drugs not covered by Medicare, or to cover the cost of drug plan co-payments.


Dual eligibles generally have more complex health conditions than other Medicare beneficiaries and use more prescription drugs. They were automatically assigned to a drug plan to ensure they would have continuous drug coverage during the Part D transition.


Yes. All people with Medicare, including those who were auto-assigned, have the right to choose their own drug plan. Dual eligibles can change drug plans throughout the year, up to once a month, as long as they are receiving Medicare and Medicaid.



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Q8. How were duals assigned to, and informed of, their plan assignment? Dual eligibles were randomly assigned a plan in October by Medicare and received a letter with their plan assignment. Plans are providing additional information to their enrollees, including details about using the plan and how drugs are covered.

Q9. Does an assigned enrollee have to take any action?

No. If an enrollee wants to keep their assigned plan, there is nothing they need to do.

Q10. Can enrollees change plans after their initial enrollment? Yes. Dual eligibles are allowed to change drug plans at any time, as long as they stay enrolled in both Medicare and Medicaid.

Q11. How can dual find out what their other plan options are?

Individual states are helping dual eligible and low income beneficiaries determine which drug plan best fits their needs. For example, in <Florida> these beneficiaries are receiving a letter that lists available drug plans in the state and matches the medications and pharmacies beneficiaries use with those offered by the plans.

Q12. Is participation in the prescription drug program required?

No, it is a voluntary program. But, if a dual eligible beneficiary does not join a Medicare drug plan, they risk losing valuable prescription drug coverage.

Q13. Are other Medicaid benefits affected by Part D?

No. A dual eligible’s other Medicaid benefits stay the same during this transition. The only benefit that changes is their primary pharmacy coverage, which moves to Medicare.

Q14. What are the costs to an enrollee of a prescription drug plan?

Dual eligibles have no premiums for their Medicare drug plans, no deductibles or coverage gaps, and pay very little or nothing at all for almost all prescriptions. The most a dual eligible will pay at the pharmacy is $5 for each medication, each time the prescription is filled. Full dual eligibles who live in nursing homes are completely subsidized by Medicare and pay nothing out of pocket for their drug coverage.

Q15. Are there other advantages to participating in a Medicare drug plan?

Medicare drug plans have extensive pharmacy networks and offer valuable consumer education, including up-front drug safety checks. Whenever an enrollee fills a prescription, their pharmacy will confirm that the drug is safe and appropriate for the enrollee. The pharmacy can also explain how to take medications for the best results.



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Q16. How does the new coverage compare with what duals have today? Each person’s situation is unique, depending on which state they live in and that state’s current prescription drug benefit. Because dual eligibles have very few costs and may receive supplemental drug coverage from their state for Medicare-excluded drugs, along with extra services and education from their pharmacy, their drug coverage will continue to be a valuable part of their overall health care benefits.

Q17. Do the Medicare plans cover all types of drugs?

While these plans cover thousands of brand-name and generic medications, there are a few types of drugs that have excluded by Medicare. Some of the excluded drugs include benzodiazepines (typically used for panic disorders and anxiety), barbiturates (usually sedatives and pain management drugs), prescription drugs for coughs and colds, prescription vitamins, and over-the-counter medications.

Q18. What if the drug an enrollee takes is not covered?

If a drug is not covered, plans will work with enrollees and their physicians to find other covered drugs that are equal to a member’s current medication, helping to maximize a member’s Medicare drug coverage.

Q19. What are drug plan providers doing to help enrollees though the transition to Part D?

All plan providers must have Medicare-approved Part D transition plans in place by January 1, 2006, that anticipate potential issues and support a smooth implementation. Some of the key elements of those plans include: offering a broad list of covered drugs with multiple options in each drug class, clearly defined exception procedures, and close collaboration with the states.



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Proactive Transition Planning for Auto-Enrolled Dual Eligibles (For Use with states, nursing homes and LTC Pharmacies – distribution possible) Dual Eligible Part D Transition Planning More than 500,000 dual eligibles have been auto-assigned to a UnitedHealth Group Part D plan, and we are working closely with CMS and the states to create a smooth transition for these enrollees. Our Part D plans were built with the needs of dual eligibles in mind and are designed to mitigate any disruption in their prescription drug coverage. Key plan elements that support a seamless Part D transition for enrollees include:

• A single formulary for all our Part D plans that exceeds USP recommendations and includes virtually every drug in the therapeutic classes and categories covered under Medicare Part D, including thousands of brand name and generic medications. Our transition plan is tied to our formulary and benefit structure and will give all new enrollees access to virtually all medication entities covered under Part D.

• Responsive exception procedures that provide access as needed to multi-source brand

name drugs. The only Part D covered drugs not included on our formulary are multi-source brand drugs. These are the branded versions of drugs for which an exact chemical equivalent is available in the same strength and dosage forms. For each multi-source brand we offer the exact generic copy on our formulary. Multi-source brand drugs are also available through an exceptions process. In addition, a limited number of multi-source brand drugs are included on our formulary for a narrow therapeutic index such as those relating to blood thinning and thyroid hormone supplementation.

• Prior authorization and step therapy requirements for a very small number of drugs.

Prior authorization is needed for only 41 medications, less than 0.2% of claims based on our experience with senior populations, and step therapy is required for just 5 medications, less than 0.5% of claims based on our experience with senior populations. Enrollees may receive a 5-day emergency supply for a number of these medications at the pharmacy while coverage determination is made, which takes no more than 24 hours for an expedited request or 72 hours for a standard request.

• Small or no co-pays for any of the drugs on our formulary. Our tiered benefit structure

collapses for full benefit dual eligibles into two tiers: generics and brands. Institutionalized full benefit dual eligibles have no co-pay. Other full benefit dual elgibles will have a co-pay of no more than $1 to $3 for a generic and $2 to $5 for a brand, including specialty drugs.

• A custom clinical structure that has special precautions for drugs dangerous to the frail

and elderly, addresses unique drug delivery needs (such as IV and liquid vs. tablet), and provides safety checks and one-on-one consultations to avoid negative drug interactions and educate enrollees about the drugs they take.



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• An extensive pharmacy network with more than 50,000 retail stores, optional mail order services, long-term care pharmacies, and specialty and community pharmacies.

• Ongoing enrollee communication and education, including custom-designed resources

for dual eligibles that explain what Part D is, how it affects them, and how to get the most from their prescription drug coverage.

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Resource Guide Cover Letter (Community/advocacy organizations)

3645 Thirlane Road NW

Roanoke, VA 24019-3061 Toll Free 1-866-691-8209

December XX, 2005 <Key Influencer name, title> <Organization> <Address> <City, St zip> Dear <name>: The new Medicare Part D prescription drug plans will bring tens of millions of Americans access to prescription drugs and improve their health. Many people in the communities you serve are undoubtedly turning to you for help and information about Part D. We wanted to take this opportunity to provide you with some useful resources and tools that will help you educate one important group that is experiencing changes in the way they receive drug coverage: individuals fully eligible for both Medicare and Medicaid. Beginning January 1, 2006, more than 6 million people fully eligible for both Medicare and Medicaid (“dual eligible”) nationwide will receive their prescription drug coverage through the new Medicare prescription drug program rather than their state Medicaid programs. To ensure that dual eligible beneficiaries would have uninterrupted prescription drug benefits, the federal government chose to automatically enroll many of these individuals into qualifying health plans with an option to switch. Many other steps have been taken to ensure a smooth transition. Dual eligibles generally have more complex health needs than other Medicare beneficiaries and use multiple prescription drugs, making it important to avoid even minor disruptions in prescription drug coverage. There have been tremendous efforts on the part of the federal and state governments, Prescription Drug Plan sponsors and non-profit advocacy organizations to ensure dual eligibles make a smooth transition to Medicare prescription drug coverage. We hope that you will join us in this initiative and that the attached materials will make the drug benefit and its application to dual eligibles simple and easy to understand for everyone. Included with this letter is a:

Medicare/Medicaid Resource Guide. This guide is for people with limited income and resources who may have questions about the new Medicare drug benefit. Not only does



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this guide help answer your questions; you can also use it as a resource to hand out to older Americans to help answer their questions.

Our Resource Guide for Low-Income Individuals is available free of charge and can be ordered to hand out to constituents or the public. If you would like to order any of these pieces, please feel free to call Kari Dornisch at 952-936-6329. If you have any additional questions <or are interested in having someone talk to you or your constituents>, please call Nancy Oliker at 952-936-3268. I appreciate your time and hope that this material is helpful in your endeavors to educate the public about Medicare Prescription Drug coverage. Sincerely, Anne-Marie Gavel Vice President, Dual Low Income



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Resource Guide (Community/advocacy organizations) A pdf of the Resource Guide was included with the original email sent. Please refer to the email for an approved copy of the guide.



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Blast Fax from WHI to participating Pharmacies

Fax To: [Click here and type name] From:

Fax: [Click here and type fax number] Date: January 11, 2007

Phone: [Click here and type phone number] Pages: [Click here and type number of pages]

Re: [Click here and type subject of fax] CC: [Click here and type name]

Urgent For Review Please Comment Please Reply Please Recycle

Comments: The start date of Medicare Part D coverage is fast approaching. As of January 1, 2006, dual

eligible individuals (eligible for both Medicaid and Medicare) will receive their prescription drug coverage through

Medicare rather than via their state Medicaid programs. As a measure to ensure that these beneficiaries have

uninterrupted prescription drug benefits, the federal government has chosen to automatically enroll many of

them into qualifying health plans.

Here are some basic facts about the auto-enrollment of dual eligible individuals : Six Basic Things to Let Dual Eligible People Know:

1. Medicaid Will No Longer Provide Their Prescription Drug Coverage. Beginning January 1, Medicare will begin to pay for outpatient prescription drugs.

2. Their Drug Benefits Are Changing. Part D plans have new sets of rules, co-pays for drugs filled and the drugs that it covers.

3. Beneficiaries May Be Charged a Small Co-payment For Their Prescriptions. They may need to pay a small co-payment, or nothing at all, for prescriptions (depending on the extra help they receive from Medicare).

4. Beneficiaries Need to Make Sure Their Pharmacies Are Contracted by Their Drug Plan. Beneficiaries will receive a listing of the pharmacy network from their Medicare drug plan provider. We will need your help in making sure they understand this.

5. Make Sure the Drugs Taken Are On Drug Formulary. Beneficiaries should use the formulary information, along with help from their doctor and pharmacist, to ensure their drug needs are met by their plan. This may entail looking at therapeutic alternatives (e.g., other brand name, generics).

6. If you have beneficiary that is unassigned, please have them contact 1-866-691-8209.

Resources will be available to you, as an influential contact for Medicare beneficiaries. Expect to see a Medicare Part D Pharmacy Kit arriving in January. This kit will help address questions that you and/or you customer may have.

Should you have questions, please call our Pharmacist Help Line at 1-888-492-2952.



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Automated Call – Outbound Call Script Call Purpose: Welcome & Educate Auto Assigns (This document is currently being reviewed by CMS – Will distribute when approved)

S5820S5805_PDP441 CMS XX/XXXX



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Call Center Q&A – Inbound

Q1. What is the Medicare prescription drug program? This federally-funded, privately administered program was created as part of the Medicare Modernization Act of 2003. It is designed to lower out-of-pocket prescription drug costs and expands access to safe, affordable medications for millions of underinsured Americans.

Q2. Why is Medicare Part D important?

Medicare’s new prescription drug plans will help bridge a major gap in American healthcare and provide a much-needed safety net, especially for beneficiaries who use multiple prescription drugs.

Q3. What does it mean for people who have Medicare and Medicaid?

Approximately 6 million Americans are fully dual eligible and receive health care benefits from both Medicare and Medicaid. Today, dual eligibles have their drug coverage through Medicaid. Starting January 1, 2006, they will receive their primary pharmacy coverage through a Medicare prescription drug plan.

Q4. When does the Medicare drug program begin?

The new Medicare prescription drug plans begin January 1, 2006 for people who enroll by December 31, 2005. On that date, dual eligibles are covered under Medicare for most of their prescription drugs.

Q5. Will Medicaid cover any medications for dual eligibles, once their Medicare plan

starts? Most states will offer some limited “wrap-around” coverage for specific drugs not covered by Medicare, or to cover the cost of drug plan co-payments.


Dual eligibles generally have more complex health conditions than other Medicare beneficiaries and use more prescription drugs. They were automatically assigned to a drug plan to ensure they would have continuous drug coverage during the Part D transition.


Yes. All people with Medicare, including those who were auto-assigned, have the right to choose their own drug plan. Dual eligibles can change drug plans throughout the year, up to once a month, as long as they are receiving Medicare and Medicaid.



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Q8. How were duals assigned to, and informed of, their plan assignment? Dual eligibles were randomly assigned a plan in October by Medicare and received a letter with their plan assignment. Plans are providing additional information to their enrollees, including details about using the plan and how drugs are covered.

Q9. Does an assigned enrollee have to take any action?

No. If an enrollee wants to keep their assigned plan, there is nothing they need to do.

Q10. Can enrollees change plans after their initial enrollment? Yes. Dual eligibles are allowed to change drug plans at any time, as long as they stay enrolled in both Medicare and Medicaid.

Q11. How can duals find out what their other plan options are?

Individual states are helping dual eligible and low income beneficiaries determine which drug plan best fits their needs. For example, in <Florida> these beneficiaries are receiving a letter that lists available drug plans in the state and matches the medications and pharmacies beneficiaries use with those offered by the plans.

Q12. Is participation in the prescription drug program required?

No, it is a voluntary program. But, if a dual eligible beneficiary does not join a Medicare drug plan, they risk losing valuable prescription drug coverage.

Q13. Are other Medicaid benefits affected by Part D?

No. A dual eligible’s other Medicaid benefits stay the same during this transition. The only benefit that changes is their primary pharmacy coverage, which moves to Medicare.

Q14. What are the costs to an enrollee of a prescription drug plan?

Dual eligibles have no premiums for their Medicare drug plans, no deductibles or coverage gaps, and pay very little or nothing at all for almost all prescriptions. The most a dual eligible will pay at the pharmacy is $5 for each medication, each time the prescription is filled. Full dual eligibles who live in nursing homes are completely subsidized by Medicare and pay nothing out of pocket for their drug coverage.

Q15. Are there other advantages to participating in a Medicare drug plan?

Medicare drug plans have extensive pharmacy networks and offer valuable consumer education, including up-front drug safety checks. Whenever an enrollee fills a prescription, their pharmacy will confirm that the drug is safe and appropriate for the enrollee. The pharmacy can also explain how to take medications for the best results.

Q16. How does the new coverage compare with what duals have today?

Each person’s situation is unique, depending on which state they live in and that state’s current prescription drug benefit. Because dual eligibles have very few costs and may



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receive supplemental drug coverage from their state for Medicare-excluded drugs, along with extra services and education from their pharmacy, their drug coverage will continue to be a valuable part of their overall health care benefits.

Q17. Do the Medicare plans cover all types of drugs?

While these plans cover thousands of brand-name and generic medications, there are a few types of drugs that have excluded by Medicare. Some of the excluded drugs include benzodiazepines (typically used for panic disorders and anxiety), barbiturates (usually sedatives and pain management drugs), prescription drugs for coughs and colds, prescription vitamins, and over-the-counter medications.

Q18. What if the drug an enrollee takes is not covered?

If a drug is not covered, plans will work with enrollees and their physicians to find other covered drugs to replace a member’s current medication, helping to maximize a member’s Medicare drug coverage.

Q19. What are drug plan providers doing to help enrollees though the transition to Part D?

All plan providers must have Medicare-approved Part D transition plans in place by January 1, 2006, that anticipate potential issues and support a smooth implementation. Some of the key elements of those plans include: offering a broad list of covered drugs with multiple options in each drug class, clearly defined exception procedures, and close collaboration with the states.



Q21. How is UnitedHealth Group specifically helping their assigned dual eligibles through

the transition? Our Part D plans were built with the needs of dual eligibles in mind and are designed to mitigate any disruption in their prescription drug coverage. Our list of drugs includes thousands of brand name and generic medications. We have responsive exception procedures that provide access as needed to brand name versions of generic drugs, if the branded drug is required.

For the very small number of drugs where plan authorization is required before a prescription is filled — just 46 out of our entire formulary — enrollees can receive a 5 day emergency supply while coverage determination is being made. Our extensive pharmacy network includes more than 50,000 retail stores across the country, optional mail order services, long-term care pharmacies, and specialty and community pharmacies, providing convenient access for enrollees.



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Q22. How can a beneficiary confirm whether they are dual eligible? The Social Security Administration (1-800-772-1213, TTY 1-800-325-0778) can help with questions about eligibility for and assistance with costs of a Medicare drug plan. For Medicaid questions, beneficiaries can call the Medicare Helpline (1-800-MEDICARE – 24 hours a day/7 days a week) and ask the operator for the telephone number for their state’s Medical Assistance or Medicaid office.

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