HD67 - Medicare Part D and Pharmacy Assistance Programs in Virginia


Executive Summary:
The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173) was enacted into law on December 8, 2003. Chief among the Act’s provisions was an amendment to the Social Security Act to create a new Part D in the Medicare program, the Voluntary Prescription Drug Benefit Program. Effective January 1, 2006, the new program established access to prescription drug insurance coverage for all individuals who are entitled to Medicare Part A or enrolled in Part B and requires an affirmative election to participate in the program. As with Part B, a monthly premium payment is required for Part D coverage.

As specified in the MMA, coverage for the new prescription drug benefit is provided through private prescription drug plans (PDPs) that offer drug-only coverage for individuals in the traditional fee-for-service Medicare program. Beneficiaries enrolled in private health plans under Part C, or Medicare Advantage (MA), may also obtain drug coverage through a PDP if the MA plan is a Medicare Advantage Private Fee-For-Service (PFFS) plan that does not offer qualified Part D drug coverage. Medical Savings Account (MSA) enrollees may also join a stand-alone PDP. Beneficiaries may also elect to receive both medical and prescription drug coverage through one entity, the Medicare Advantage Prescription Drug (MA-PD) plan. All participating insurance plans must meet financial and operational requirements established by the Centers for Medicare and Medicaid Services (CMS), the designated administrator for Part D. In 2006, there were more than 40 of the above options to choose from for Virginia’s Medicare beneficiaries.