Stream: Da Vinci PDex Drug Formulary
Topic: Formulary Coverage Plan
Corey Spears (Oct 15 2021 at 16:56):
Posted by @Kimberly Walker (From #CARIN IG for Blue Button® )
I have been researching the Formulary CoveragePlan CARIN IG and am stuck.
We are a MA special needs plan with Part D.
Many of our members have CMS Low Income Subsidy (extra help) that would help pay for drugs.
Where would I find the IG documentation to represent Low-Income Subsidy copay for Formulary Coverage Plan.
Thank you in advance for your help!
Corey Spears (Oct 15 2021 at 16:59):
I believe this question warrants some discussion in the weekly PDex Implementer meetings held Fridays at 12pm Eastern.
http://www.hl7.org/concalls/CallDetails.cfm?concall=57068
Might you be able to attend? If not, we will still look at discussing during the next meeting (@Vanessa Candelora )
The IG doesn't address special copay amounts within a coverage plan and tier. Does this subsidy actually change the copay amount or is it applied afterwards? Are there special rules that define this subsidy or is this something that can be defined through the coveragePlan and tier?
Kimberly Walker (Oct 15 2021 at 19:38):
Thank you so very much for the response.
Yes. I will attend. I have put it on my calendar...thank you very much for the invite!
It does change the copay amount. And yes there are CMS rules that define the subsidy and the specific levels 1, 2, 3, and 4. Each plan then has a copay amount associated with each level.
Last updated: Apr 12 2022 at 19:14 UTC
