Re: Medicare Managed Care Plans and Immunosuppressant Coverage in 2011 [1 Attachment]

[Guest guest]

We have plenty of patients who have Medicare Advantage plans that are already structured like this. They have to follow Medicare guidelines and pay like Medicare B would pay for immunosuppressive medications. Medicare B covers at 80% and the patient is responsible for the remainder (unless they have a supplement plan). However, most of the Medicare Advantage plans also have a stop loss that includes coinsurances for part B meds. Once that amount is met, then the plan pays at 100% including immunos. Is there a stop loss w/ these plans?

Leah Knowles

CMC

Charlotte NC

Subject: Medicare Managed Care Plans and Immunosuppressant Coverage in 2011 [1 Attachment]To: txfinancialcoordinators Date: Wednesday, December 1, 2010, 12:16 PM

Hello everyone

Recently here at my organization we learned of upcoming changes in 2011 with the Blue Cross Blue Shield Medicare Managed Care Plans Keystone 65 and Personal Choice 65 and reimbursement for immunosuppressant medications.

In 2011 transplant recipients with the above-mentioned plans will become responsible for the 20% coinsurance of their immunosuppressant medications. This is going to have a huge impact on the Pennsylvania transplant patient community and I was wondering if anything similiar to what I have described has happened with the Medicare Managed Care products in your state and if so how did you center handle it.

I have enclosed the benefits information from the 2011 Evidence of Coverage for Keystone 65 Rx HMO

[Guest guest]

Bessie your attachment could not be opened. Can you send it to me directly at

jeason@.... I'll want to have our contracting people take a

look at it and see if similar wording is in the new advantage contracts in our

state.

Julius C. Eason

Transplant Financial Coordinator

Multi-Organ Transplant

Beaumont Hosp., Royal Oak

(P) , (F)

jeason@...

>>> Bessie Plummer 12/1/2010 12:16 PM >>>

Hello everyone

Recently here at my organization we learned of upcoming changes in 2011 with the

Blue Cross Blue Shield Medicare Managed Care Plans Keystone 65 and Personal

Choice 65 and reimbursement for immunosuppressant medications.

In 2011 transplant recipients with the above-mentioned plans will become

responsible for the 20% coinsurance of their immunosuppressant medications. This

is going to have a huge impact on the Pennsylvania transplant patient community

and I was wondering if anything similiar to what I have described has happened

with the Medicare Managed Care products in your state and if so how did you

center handle it.

I have enclosed the benefits information from the 2011 Evidence of Coverage for

Keystone 65 Rx HMO