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<p class=MsoNormal style='margin-bottom:12.0pt'><b><font size=2 face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma;font-weight:bold'>Subject</span></font></b><font
size=2 face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'>: CMS
Proposes "Trial Sizes" Of Prescriptions To Curb Waste Of Unused Drugs
In Part D </span></font><o:p></o:p></p>
<p class=MsoNormal style='mso-margin-top-alt:15.0pt;margin-right:7.65pt;
margin-bottom:9.0pt;margin-left:11.4pt'><font size=1 color="#736f6e"
face=Arial><span style='font-size:8.5pt;font-family:Arial;color:#736F6E'>February
24, 2010 <o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:15.0pt;margin-right:7.65pt;
margin-bottom:9.0pt;margin-left:11.4pt'><font size=5 face="Times New Roman"><span
style='font-size:16.5pt'>CMS Proposes "Trial Sizes" Of Prescriptions
To Curb Waste Of Unused Drugs In Part D </span></font><o:p></o:p></p>
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<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>CMS, in an effort to contain health care costs and the waste
associated with unused drugs, is asking Medicare Part D prescription drug
plan sponsors to allow beneficiaries to get a seven- to 14-day supply of a
medication that is new to the beneficiary.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>In a draft version of the 2011 Part D plan call letter released Feb.
19, CMS asserts that a trial-size fill of a new medication would motivate
"the beneficiary to request partial fills in order to gauge tolerance
of the new drug. By allowing plan members to obtain a partial fill for new
medications, the member may try the medication and return to the pharmacy
for the full amount when the patient has demonstrated a tolerance for the
new medication." Current physician prescribing patterns and pharmacy
benefit management practices typically result in most prescription
medications being dispensed for 30- or 90-day periods, the agency says.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>CMS also says that when the full dispensed amount of drug is not
utilized by the patient due to death, adverse reactions, medication
substitution or other reasons, "the remaining unused medication
becomes waste." The agency adds that it also becomes an environmental
hazard when it is disposed and could be a safety hazard in the home or
diverted for illegal usage.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>The availability of trial size prescriptions "may serve as a
substitute for physicians' practice of giving patients samples of
medications that may not be compatible with the patient's Part D plan
formulary," CMS notes.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>Finally, the offering of trial sizes "promotes savings to the
beneficiary, Part D sponsor and Medicare program," though the agency
did not quantify how much could be saved.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>CMS notes that a review of 2007 prescription drug event data
"suggests that up to as many as 30 percent of first fills for chronic
medications are not refilled. If the disincentive of paying the full cost
sharing amount was eliminated, and copays were prorated for the amount
actually dispensed, beneficiaries might appreciate the opportunity to
request an initial trial fill for new medications."<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>The annual call letter outlines rules for Part D plan sponsors to
use in designing their plans for the upcoming year.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>The draft call letter also brings attention to the transference of
coverage of drugs used to treat end-stage renal disease from Part D to Part
B. CMS currently is reviewing rules for a prospective payment system that
would bundle all ESRD services and drugs, which would be paid under Part B.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>CMS also is seeking comment on a proposal to include low-income
subsidy recipients who have chosen their plans among those CMS can reassign
to new plans based on plan bids. Previously, the agency only has reassigned
those who were auto-enrolled in a plan.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>"For the fall of 2010, we are considering expanding
reassignment to these 'choosers' based on their 2011 premium liability, for
example, if their 2011 premiums will be $10 or greater. We are concerned
that these beneficiaries - despite targeted outreach - may not fully
understand they have less expensive alternatives."<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>The change could lead to the reassignment of 580,538 beneficiaries,
based on the number of 2010 LIS choosers in plans with premiums of $10 or
more.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:
auto'><font size=3 face=Arial><span style='font-size:12.0pt;font-family:
Arial'>CMS says in the draft letter that it is planning on maintaining the
$600 threshold for drugs in the specialty tier.<o:p></o:p></span></font></p>
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style='font-size:12.0pt'><o:p></o:p></span></font></p>
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<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#993366"
face="Goudy Old Style"><span style='font-size:10.0pt;font-family:"Goudy Old Style";
color:#993366'>Stevan Gressitt, M.D., Medical Director</span></font><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#993366"
face="Goudy Old Style"><span style='font-size:10.0pt;font-family:"Goudy Old Style";
color:#993366'>Office of Adult Mental Health Services</span></font><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#993366"
face="Goudy Old Style"><span style='font-size:10.0pt;font-family:"Goudy Old Style";
color:#993366'>Department of Health and Human Services</span></font><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><st1:place w:st="on"><st1:PlaceName
w:st="on"><font size=2 color="#993366" face="Goudy Old Style"><span
style='font-size:10.0pt;font-family:"Goudy Old Style";color:#993366'>Marquardt</span></font></st1:PlaceName><font
size=2 color="#993366" face="Goudy Old Style"><span style='font-size:10.0pt;
font-family:"Goudy Old Style";color:#993366'> <st1:PlaceType w:st="on">Building</st1:PlaceType></span></font></st1:place><font
size=2 color="#993366" face="Goudy Old Style"><span style='font-size:10.0pt;
font-family:"Goudy Old Style";color:#993366'>, 2nd Floor</span></font><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#993366"
face="Goudy Old Style"><span style='font-size:10.0pt;font-family:"Goudy Old Style";
color:#993366'>11 State House Station</span></font><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><st1:Street w:st="on"><st1:address
w:st="on"><font size=2 color="#993366" face="Goudy Old Style"><span
style='font-size:10.0pt;font-family:"Goudy Old Style";color:#993366'>32
Blossom Lane</span></font></st1:address></st1:Street><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><st1:place w:st="on"><st1:City
w:st="on"><font size=2 color="#993366" face="Goudy Old Style"><span
style='font-size:10.0pt;font-family:"Goudy Old Style";color:#993366'>Augusta</span></font></st1:City><font
size=2 color="#993366" face="Goudy Old Style"><span style='font-size:10.0pt;
font-family:"Goudy Old Style";color:#993366'>, <st1:State w:st="on">ME</st1:State>
<st1:PostalCode w:st="on">04333-0011</st1:PostalCode></span></font></st1:place><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#993366"
face="Goudy Old Style"><span style='font-size:10.0pt;font-family:"Goudy Old Style";
color:#993366'>Ph: (207)287-4273</span></font><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#993366"
face="Goudy Old Style"><span style='font-size:10.0pt;font-family:"Goudy Old Style";
color:#993366'>Fax: (207)287-1022</span></font><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#993366"
face="Goudy Old Style"><span style='font-size:10.0pt;font-family:"Goudy Old Style";
color:#993366'>Cell Phone: (207) 441-0291</span></font><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#993366"
face="Goudy Old Style"><span style='font-size:10.0pt;font-family:"Goudy Old Style";
color:#993366'>E-Mail : <a href="mailto:stevan.gressitt@maine.gov"
title="mailto:stevan.gressitt@maine.gov">stevan.gressitt@maine.gov</a><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><u><font size=1 color=blue
face="Goudy Old Style"><span style='font-size:9.0pt;font-family:"Goudy Old Style";
color:blue'><a href="http://www.maine.gov/dhhs/mh/">http://www.maine.gov/dhhs/mh/</a></span></font></u><o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'> <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-align:justify'><em><b><i><font
size=1 color=black face="Goudy Old Style"><span style='font-size:8.0pt;
font-family:"Goudy Old Style";color:black;font-weight:bold'>Confidentiality
Notice</span></font></i></b></em><font size=1 color=black face="Goudy Old Style"><span
style='font-size:8.0pt;font-family:"Goudy Old Style";color:black'>: This e-mail
message, including any attachments, is for the sole use of the intended
recipient(s). It may contain confidential and privileged
information. Any unauthorized review, copy, use, disclosure, or
distribution is prohibited. If you are not the intended recipient, please
note that any dissemination, distribution or copying of this is strictly
prohibited. Please contact me by reply e-mail or telephone and destroy
all copies of<b><i><span style='font-weight:bold;font-style:italic'> </span></i></b>this
message</span></font><font size=1 color=blue face="Goudy Old Style"><span
style='font-size:8.0pt;font-family:"Goudy Old Style";color:blue'>.</span></font><font
size=1 face="Goudy Old Style"><span style='font-size:8.0pt;font-family:"Goudy Old Style"'><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-align:justify'><font size=1
color=black face="Goudy Old Style"><span style='font-size:8.0pt;font-family:
"Goudy Old Style";color:black'>The Department of Health and Human Services
(DHHS) does not discriminate on the basis of disability, race, color, creed,
gender, sexual orientation, age, or national origin, in admission to, access
to, or operations of its programs, services, or activities, or its hiring or
employment practices. This notice is provided as required by Title II of the
Americans with Disabilities Act of 1990 and in accordance with the Civil Rights
Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1973, as
amended, the Age Discrimination Act of 1975, Title IX of the Education
Amendments of 1972 and the Maine Human Rights Act and Executive Order Regarding
State of Maine Contracts for Services. Questions, concerns, complaints or
requests for additional information regarding the <u1:place w:st="on"><u1:City w:st="on"><st1:City
w:st="on"><st1:place w:st="on">ADA</u1:City></st1:City></st1:place></st1:City>
may be forwarded to DHHS’ ADA Compliance/EEO Coordinators, <u1:address w:st="on"><u1:Street w:st="on"><u1:Street w:st="on"><u1:address w:st="on"><st1:address
w:st="on"><st1:Street w:st="on">11 SHS-221 State Street</u1:address></u1:Street></u1:address></u1:Street></st1:Street>,
<u1:City w:st="on"><st1:City w:st="on">Augusta</u1:City></st1:City>, <u1:State w:st="on"><st1:State
w:st="on">Maine</u1:State></st1:State> <u1:PostalCode w:st="on"><st1:PostalCode
w:st="on">04333</st1:address></st1:PostalCode></st1:address>, 207-287-4289
(V), 207-287-3488 (V), 1-800-606-0215 (TTY). </span></font><font size=1
face="Goudy Old Style"><span style='font-size:8.0pt;font-family:"Goudy Old Style"'><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
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