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Attention all ADAP Clients Also Enrolled in Medicare Part D
NOTE: This applies ONLY to clients
also enrolled in Medicare Part D

The Florida Department of Health has instituted a statewide change in the AIDS Drug Assistance Program (ADAP) affecting all ADAP medications for clients who are also enrolled in Medicare Part D.

Effective immediately, affected ADAP medications will be dispensed from the Department of Health Central Pharmacy in Tallahassee and not the Broward County Health Department (BCHD) Pharmacy. The Central Pharmacy will fill the prescription and mail it to the BCHD ADAP office in the Fort Lauderdale Health Center (FLHC), 2421 SW 6th Avenue – Fort Lauderdale, 33315. Any concerns with new prescriptions, refills, certifications and recertifications for dually eligible clients will be handled at the ADAP Eligibility Department at FLHC:

• New prescriptions can be dropped off at the FLHC Q-Flow window during regular business hours. Providers (ONLY) can fax new prescriptions to our secured fax line: (954) 467-4861.

• Appointments for certifications and six-month recertifications can be made through the appointment line: (954) 713-3196.

• Refill requests can be called in at (954) 290-2728.

• You will be called when your medication has arrived from the Central Pharmacy. It is important that clients provide staff with the most updated contact phone number(s).

• Times for medication pick-ups: Monday, 8:00am until noon and Thursday,
1:00pm – 5:00pm. Stop at the Q-Flow window and let the receptionist know you
were called for a pick-up.

NOTE: This applies ONLY to clients also enrolled in Medicare Part D

Please don’t wait until you are out of a medication, allow for the extra time to receive the medication from Central Pharmacy.

The BCHD will make every effort to assist you in this process.
Please call (954) 713-3196 with any questions.

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Florida ADAP Premium/Plus AIDS Drug Assistance Program
Client’s Frequently Asked Questions -MEDICARE PART D/TrOOP
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In order to receive Medicare Part D coverage, persons who are eligible to receive Medicare must sign up for a prescription drug plan (PDP) that is either stand-alone or offered through a Medicare Advantage plan. Part D provides an outpatient prescription drug benefit for anyone
receivine Part A or enrolled in Part B.
******************************************************

1. What is TrOOP?True out-of-pocket (TrOOP) costs are expenses
that count toward your Medicare drug plan out-ofpocket
costs of $4,550 (for 2010 and 2011).
2. What is Low-Income Subsidy (LIS)Low-Income subsidy is also known as “extra help”.
It lowers the costs of your Medicare prescription
drug coverage. If you are eligible to receive
Medicare, you should apply for LIS.
3. How do I qualify for the Low-Income Subsidy
(LIS)? You may be able to get extra help to pay
for your monthly premiums, annual deductibles,
and co-payments related to the Medicare
Prescription Drugs. You must be enrolled in a
Medicare Prescription Drug plan to get this extra
help. For more information call Social Security tollfree
at 1-800-772-1213 (TTY 1-800-325-0778) or
visit: http://www.socialsecurity.gov .
Your case manager or ADAP contact in your area
may be able to assist.
4. When will ADAP dollars be eligible to count
towards TrOOP?
Beginning January 1, 2011.
5. Will I be able to remain in ADAP if I cannot
afford to access (i.e., pay deductibles or
co-pays) my Medicare benefits?
Yes. ADAP will continue to serve you if you cannot
afford to access your Medicare plan.
6. If ADAP count towards TrOOP, will ADAP be
able to help me pay my deductible and/or copayments?

In April 2011, ADAP will contract with a provider to
assist with co-payments and possibly deductibles.
7. What are my responsibilities while enrolled as a
client of the ADAP Premium Plus Program?
You must pay your deductible and maintain your
plan premiums for Medicare Part D. If you are
unable to cover your deductibles, ADAP will serve
you. See Question 5.
You must apply for the Low-Income Subsidy (LIS),
also known as, Extra Help.
8. What is ADAP Premium Plus?ADAP Premium Plus is a new module within
the ADAP database specifically created to manage
clients with private insurance and Medicare Part D.
9. Will I be able to remain in ADAP after I have
gotten through the Donut Hole?
Yes. ADAP will continue to serve as your
medication benefits coordinator.
10. How will I be notified when I reach catastrophic
coverage?
Your Medicare Prescription Plan keeps track of
your TrOOP costs. Every month that you buy or
receive prescriptions covered by your plan, you will
get an explanation of benefits (EOB) in the mail
showing your TrOOP costs to date.
11. Will I be terminated from ADAP Premium Plus if
I don’t continue my Medicare Part D premiums?
Yes. A client who is eligible must be enrolled in
Medicare Part D in order to continue to receive
ADAP services and assistance with TrOOP.

*****************************************************
For more information regarding Medicare Part D call Social Security toll-free at
1-800-772-1213 (TTY 1-800-325-0778) or visit: http://www.socialsecurity.gov .
Your case manager or ADAP contact in your area may also be able to assist you.

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ADAP News

Good News for ADAP – Medicare Part D.

While Broward County Health Department awaits guidance from the state, ADAP clients with Medicare Part D can continue to get their antiretroviral meds and Opportunistic Infection meds from ADAP. This is great news for now! If you are told otherwise, please ask them to talk to William Patrick or Paul Moore in the HIV/AIDS Program Office. This does not mean that we do not still need Activism at both the State and Federal level because the lack of funding is still critical.

Tim.

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From: Paul A. Moore, MSW
HIV/AIDS Program Director
Broward County Health Department
780 SW 24th Street
Fort Lauderdale, Fl 33315
Tel: 954-467-4700 Ext. 5590
Fax: 954-598-3209

Sent: Thursday, December 16, 2010

Subject: ADAP & Medicare Part D – Good News
Importance: High

It was just announced on a statewide ADAP conference call that current ADAP clients on Medicare Part D can continue on ADAP if they cannot afford the Part D associated costs. Clients should contact ADAP at (954) 467-4700 ext 5630 if they qualify

****************************************************
Our comment:
This is vague information, but good news. “Cannot afford the Part D associated costs” is open to interpretation, but hopefully will be explained soon.

-Steve and Tim

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From Tim:

I have been locked in a fierce battle for the Medicare Part D clients with ADAP regarding coverage once they reach Catastrophic. It seems as if I have lost. The answer I keep getting is that coverage for the “Doughnut Hole” is better than no coverage at all and that people with no other serious illness get assistance with their medication costs so they should be grateful they have not been cut entirely. Please get these clients to attend both the Tuesday SFAN meeting and the Wednesday Town Hall meeting as they really need for their voices to be heard. I have also been hit back with the idea that people chose not to vote on Election Day so we have to deal with the consequences. We desperately need Congress to provide additional funding and need to mobilize as a community.

Unless we can get them to change their mind, the rule is as follows for Medicare + ADAP:
1. Client must carefully pick a plan during the open enrollment plan which began today and runs through December 31, 2010 for plan to start on January 1, 2011.

2. They will be required to go to a retail pharmacy for their medications until they reach the Doughnut Hole. This will happen in January or February for most patients. They need to get the pharmacy to give them a print-out showing they have reached the Doughnut Hole and then they can briefly return to ADAP. ADAP will only assist them with HIV meds and Opportunistic Infection Drugs during this phase until the patient emerges from the Doughnut Hole and hits the “Catastrophic Phase.” Catastrophic occurs when the amount of True Out of Pocket Costs from the patient, ADAP and the 50% discount for Brand Name drugs provided by drug manufacturer’s reaches $4550. They are assuming that ADAP will only be assisting these clients for 2 months at most.

3. At this point, they will have to go back to retail pharmacy for remainder of year for ALL DRUGS and pay $2.50 generic, $6.30 brand, or 5% whichever is greater. For HIV drugs in particular it is going to be the 5% and can get really costly.

4. They need to work with their doctors to lower their costs, perhaps switching to low cost generics in any way possible to use the Walmart/Target $4 list, but ultimately their costs are going to increase A LOT. Some might want to join Medicare Advantage plans so they do not have to pay a premium. I have a feeling that Positive Healthcare Partners will be doing a big sell at the Town Hall meeting.

I know this is awful news, but I have fought this battle extremely hard without being able to win. I have given them specific examples yet I can get no one in power to see the harm this can cause. I have also been unsucessful in getting Ryan White Pharmacy to even consider helping those with Medicare Part D. I plan to keep fighting, but we really need to mobilize like we are back in the 1980’s again.

It is strongly encouraged that those who do not have many assets who may be above the 150% Federal Poverty Level ($16,245) apply for Extra Help at http://www.ssa.gov as they sometimes allow people with higher incomes on.

As far as those who are ADAP without Medicare, the change of reducing eligibility from 400% Poverty ($43,320) to 300% Poverty ($32,490) will not happen until February 1, 2011 instead of the December 1, 2010 we were dreading. If anyone in the group falls into this category, they need to meet with a Patient Assistance Program Navigator or their Case Manager to apply for Patient Assistance Programs as soon as possible. I have been told that these affected people “should” all be able to get all of their HIV medications from the Patient Asssistance Programs.

I hope you will post this or at least pass on to the group. If the SFAN meeting and the Town Hall meeting receive poor attendance, the will of Community Advocates will probably decrease.

I will assist any group member in any way that I can. Just ask.

Sincerely,
Tim

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Beginning January, 2011, AIDS Drug Assistance Program dollars will count toward Medicare client’s True-Out-of-Pocket costs (TrOOP). This is great news for our program as it will maximize the state’s use of federal dollars as well as free up funding to help address the current ADAP crisis.

To ensure ADAP is the payer of last resort, all Medicare Part D clients, who are currently enrolled in ADAP will be required to access their Medicare Part D benefits beginning January 1, 2011. Clients who have Medicare Part D will be de-selected in the ADAP database, but their status will be labeled “open and active” while they access their insurance. Clients may only return to ADAP for medication assistance once they reach the Donut Hole in their coverage. (Official language from ADAP State Program Director).

It may be great news for the ADAP program to save money, but it is not great news for those with Medicare Part D who use ADAP. Plan information is now online at http://www.Medicare.gov. When comparing plans, you particulary want to look at the Monthly Premium, Annual Drug Deductible, and the total amount you would spend in the Initial Coverage Level. Under the column of Coverage Gap, look at how much you would pay for any drug that is not on the ADAP drug list. Finally, look at how much your costs would be in the Catastrophic Phase. With ADAP money being so tight, it has yet to be determined if they will help Medicare Part D clients once they are out of the Coverage Gap and into Catastrophic. Once you enter your drugs, the plans that come up as lowest cost may not truly be lowest cost for you; they are the lowest cost plans if you did not have the ADAP help in the Coverage Gap (Donut Hole). Please review carefully.

I have never been much of an advocate for Medicare Advantage plans for those in this category, but they may be the lowest cost options for you now since the ones I list have $0 Monthly Premium. I cannot tell you what plan to pick, but I can give my opinion. I know these options are already being used by many with higher incomes who do not qualify for ADAP. The two I like best for HIV patients are Avmed Medicare Choice (www.avmed.org) and Postive HealthCare Partners (www.positivehealthcare.org). It is VERY IMPORTANT when choosing a Medicare Advantage plan to make sure that any doctors you want to keep are on the plan, and it’s always a good idea to discuss what your doctor thinks of the plans you are considering. Both of these plans have most of our HIV Primary Care Physicians as providers.

Other people who need lower cost sharing use plans like Humana Gold Plus Plan 65C (www.humana-medicare.com) or Medica HealthCare Plans MedicareMax Direct (www.medicaplans.com). There is a trade off for the lower cost of having to pick a non-HIV Primary Care Physician and be referred to an Infectious Disease Specialist. This is not an endorsement of any of these plans and please review them carefully. It is perfectly fine to stay with Original Medicare and a Stand-Alone Drug Plan instead.

Pharmacists or Pharmacy Reps from HIV Specialty Pharmacies are also great sources of information. The annual enrollment period begins November 15 through December 31, 2010. If you are happy with the plan you have, you do not need to do anything. There are so many plans it can be very confusing. I hope this is helpful. Tim

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