Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
If you are an entity that provides pharmacy benefits to its employees or members, then we know your primary concern is likely taking care of those who are currently still active in your place of work. But, if you also offer pharmacy benefits to employees who are retired, then it is important to be aware of the aid you may be eligible to receive from the government.
The Retiree Drug Subsidy Program is an opportunity available through Medicare that allows providing entities to continue offering eligible retirees employer sponsored coverage similar to what they received as an active employee. According to the Centers for Medicare and Medicaid Services, "it is generally considered the easiest and most straightforward of the available options, and can often be implemented with little or no benefit design changes to current coverage." That means that those who qualify are likely to be able to receive the same pharmaceutical services they once did even though they are no longer in a position of employment.
To be eligible for the reimbursement (as of January 1, 2006, the government provides a 28% drug subsidy for qualified plans), the Pharmacy Benefit Plan must be equal to or better than the Medicare Part D plan. Furthermore, it is required that an evaluation is completed and signed by a certified actuary, and an application must be submitted to the RDS program 90 days before the plan becomes effective.
How We Help
Here at PBIRx, we have dedicated a division within our company, Pharmacy Benefit Actuarial Services (PBAS), which handles the entire application process for clients seeking the Retiree Drug Subsidy. We have a team of actuaries who possess the certifications needed that can guide you through each of the necessary steps in order to determine your eligibility and ultimately, to receive the subsidy if approved. Below is just some of what we will do to get started:
- Provide a courtesy review of date including estimated subsidy amount and estimated PBAS services fee.
- Determine if your plan is eligible.
- Determine if a modification of the plan will make you eligible if you are not already eligible.
- Communicate all employer paperwork deadlines required by the government.
- Develop and participate in a communication strategy for your Medicare eligible employees.
To find out if you are eligible and move forward with the process, we encourage you to give us a call and set up an appointment for your FREE consultation!