Carmelo Gonzalez News Page 22

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Things that are going on that you might want to know.

105

PART D PLANS PROTEST 2007 FORMULARY GUIDANCE

       In a surprising role reversal, consumer advocates praised the Centers for Medicare & Medicaid Services (CMS) for its proposed 2007 transition guidance for Part D plans and encouraged the agency to implement stronger protections for people with Medicare immediately instead of waiting until 2007.
       Meanwhile, the Part D drug plans are chafing at the prospect of operating under the proposed regulations. The draft formulary guidance for 2007 rejects a call by Part D plans to nix the requirement that all formularies cover “substantially” all drugs within six categories (antidepressants, antipsychotics, anticonvulsants, anticancer medicines, immunosuppressants, and HIV/AIDS drugs). The proposed guidance allows only limited exclusions of drugs in these six classes, such as extended release versions and medicines with the same active ingredient as other drugs that are covered.
       Drug manufacturers are critical of a new CMS proposal that would allow plans to place more medicines on the so-called specialty tier of their formularies. For drugs placed on the specialty tier, no appeals for lower cost sharing are allowed. CMS is also proposing to allow plans to raise cost sharing on the specialty tier above 25 percent, the current limit.
        Under the proposal, only drugs costing more than $500 per month can be placed on the specialty tier. At present, CMS does not impose a threshold amount, but only very high-cost specialty drugs are included on the specialty tier.
       From a different point of view, consumer advocates and nursing home pharmacists lauded provisions in the 2007 draft regulations for strengthening regulation and control over Part D plans.
       In particular, advocates applauded CMS for signaling it will exercise greater oversight of drug plans’ utilization management tools, such as requirements for prior authorization, step therapy—mandating that an alternative medicine is tried first—and quantity limits.
       “[CMS] will check the formulary to ensure inclusion of a range of drugs in a broad distribution of therapeutic categories and classes . . . [w]e will also consider the specific drugs, tiering and utilization management strategies employed in each formulary,” says the 2007 draft guidance.
       The American Society of Consultant Pharmacists (ASCP) also encouraged CMS to require full coverage of medications for Alzheimer’s and Parkinson’s patients.
       Plans must provide at least one 30-day temporary supply of nonformulary medicines or medicines restricted by utilization management tools during the first 90 days of enrollment, under CMS proposed transition rules for 2007. CMS also proposed to require Part D plans to provide transitional supplies of nonformulary or restricted medicines for plan enrollees transitioning to a new level of care, such as those moving from the hospital to the home.
       While applauding these regulations, pharmacy and consumer advocates encouraged CMS to implement these regulations immediately, and to go even further to ensure that people with Medicare are able to access the medicines they need.
       The final formulary guidance will be issued in mid-March, according to a CMS official.

106

Peace is not just for women

CodePink and a delegation of Iraqi women will deliver a Global Call for Peace to the White House on March 8.

Put your name with theirs.

Dear Anne,

Since before the Iraq War began, TrueMajority members have been raising their voices for peace. News stories, polls and editorials show that the majority of Americans are coming around, and we should be encouraged as we get our second wind to continue this struggle.

Our friends at CodePink have been leaders as well, with a constant flow of bold, creative actions spreading the message that Americans of all stripes do not want Iraqis killed in our name. They’ve offered TrueMajority members the chance to join in on their latest campaign – a Call for Peace in honor of International Women’s Day, which will be delivered by a huge crowd in Washington D.C. along with a delegation of Iraqi women. We think it’s a great idea, and hope you will, too. ANYONE can sign, whether you're a woman or just the child of one.

To have your name put on the Call for Peace, click the link below:

Or visit:

http://action.truemajority.org/campaign/womensayno/w3dwk5w205bb83n?

You can also join the march in Washington on Wednesday, March 8th, or hold a support rally in your hometown; CodePink has more info on how at their website (below).

Matt Holland
TrueMajority Online Director

Here’s the message from our friends at CodePink:

This week we have seen escalating brutality in Iraq claiming the lives of 1,300 people, a poll exposing the desire of 72% of the U.S. soldiers to leave Iraq, and George Bush’s approval ratings plunging to the lowest levels of his presidency. We must act now. We must join together across the borders to end this madness.

Next week, in celebration of International Women's Day, a courageous group of Iraqi women will converge in Washington DC. They represent Shias, Sunnis and Kurds, religious and secular women. They are united in their horror at the killings, and their determination to stop the violence.

We owe it to them to stand with them in solidarity. You can do that by signing the Urgent Call for Peace, circulating it, and participating in an anti-war action on International Women's Day. Click here to find an event in your community.

One of our delegates told us that in Baghdad these days, there are dead bodies on the streets and pools of blood on the sidewalks, that parents are keeping their children locked inside their homes. Fear is everywhere.

As we say in our call, "This is not the world we want for ourselves or our children. With fire in our bellies and love in our hearts, we women are rising up - across borders - to unite and demand an end to the bloodshed and the destruction."

And if you don't see one, pull something together--fast. It can be as simple as downloading a copy of our Urgent Call for Peace, representing the signatures of tens of thousands of women worldwide, and taking it to your Embassy or congressperson. Click here to download.

Join us,

Dana, Farida, Gael, Jodie, Medea, Nancy, Rae & Tiffany

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TrueMajority.org, 191 Bank Street, Third Floor, Burlington, VT 05401

107

DisabilityInfo.gov Website

DisabilityInfo.gov is a one-stop federal website designed to offer people with disabilities and many others access to the information and resources they need to live full and independent lives in the workplace and in their communities. Managed by the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP), DisabilityInfo.gov offers a broad range of valuable information, not only for people with disabilities, but also their family members, employers, service providers and many others.

Easy to navigate, DisabilityInfo.gov is organized by subject areas that include benefits, civil rights, community life, education, employment, health, housing, technology and transportation. In the spirit of the National Council on Disability’s (NCD) mission, the website features resources on policies, programs and practices that promote equal opportunity for all individuals with disabilities. Visitors to the website can also access resources at the state and local level that support the full integration of adults and youth with disabilities in their communities, their schools, and in the workplace.

With 21 federal agencies, including NCD, contributing content to this website, DisabilityInfo.gov contains extensive, frequently updated information on a host of cross-cutting topics. Resources of particular interest to NCD’s constituents include information about the Americans with Disabilities Act (ADA), as well as programs and policies that promote the economic independence of individuals with disabilities

108

CMS IMPLEMENTS EXCEPTIONS POLICY TO THERAPY CAP

The Centers for Medicare & Medicaid Services (CMS) has instructed its contractors on how to implement an exceptions process for the annual per-beneficiary cap on outpatient rehabilitation therapy that took effect on January 1 with the expiration of a two-year moratorium.

The cap limits physical therapy, occupational therapy and speech-language pathology provided on an outpatient basis outside of a hospital to $1,740 per year.

The exceptions policy, which was mandated by the budget reconciliation bill passed by Congress in early February, automatically allows therapy above the cap to be provided for a range of conditions, including joint replacements and limb fractures, speech aphasia, multiple sclerosis, Parkinson’s disease and brain hemorrhages. The policy also provides an automatic exemption from the cap if the patient had already received therapy earlier in the year for a separate condition. Post-therapy evaluation is also automatically exempted from the cap.

Providers can seek an exception to the cap for therapy that does not meet these criteria. If contractors fail to respond within 10 days, an automatic exception is granted.

109

New funding opportunities from the Quality Mall web site:

Help America Vote Training and Technical Assistance to Assist Protection and Advocacy Systems to Establish or Improve Voting Access for Individuals with Disabilities http://www.qualitymall.org/funding/fundingdetail.asp?postingid=361

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