Rules change on coverage

KNIGHT RIDDER NEWSPAPERS
Q. I signed up for a Medicare drug plan earlier in the year. I have been pleased that the plan covers all of the drugs I'm taking. However, I heard that my Medicare drug plan could stop covering any of the drugs that I take at any time during the year. Is that true? -- Donald
A. Up until recently, Medicare drug plans were allowed to make changes to the list of drugs they cover (the formulary) at any point during the year, as long as they provided notice to the Medicare program and to any enrollee who was taking that drug. Since many beneficiaries enrolled in a plan only after making sure all their drugs were covered, it seemed unfair to allow plans to drop drugs in the middle of the year, while enrollees had to stay with their Medicare drug plan for the remainder of the year.
In response to these concerns, the government recently announced a change in rules that prohibits Medicare drug plans from dropping a drug that an enrollee is taking. There are a couple of exceptions. A plan may drop a drug from its formulary if the drug is determined to be unsafe, or if the plan replaces a brand-name drug with a newly available generic alternative. Medicare drug plans may still change their formularies and stop covering certain drugs during the year, but these changes will not affect enrollees who are already taking that particular medication.
Keep in mind that plans are still allowed to make formulary changes from one year to the next, so it is important to re-evaluate your current plan at the end of 2006 and decide whether to stick with that plan or change to a different one for 2007.
For the rest of 2006, however, you no longer have to worry that your plan will stop covering any of the medications that you now take.
This column was prepared by the Kaiser Family Foundation, an independent, nonprofit private foundation based in Menlo Park, Calif., not affiliated with the Kaiser Permanente health plan. Send questions about the new Medicare drug benefit to Medicare Q & amp; A, The Kaiser Family Foundation, 1330 G St., NW, Washington, DC 20005 or MedicareQ@kff.org.