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According to a Morbidity
and Mortality Weekly Report released by the Centers
for Disease Control and Prevention (CDC) earlier this year, the rate of new
lung cancer cases in the United States decreased from 2005 to 2009.
Specifically, the study found that new rates of lung cancer went down 2.6
percent each year among men, and 1.1 percent each year among women. The study
also found that the fastest drop in new lung cancer rates occurred among adults
ages 35-44 years old. The study used data from the used 2005-2009 data from the
National
Program of Cancer Registries and the National Cancer Institute’s Surveillance,
Epidemiology, and End Results program. According to the report’s press release, smoking continues to be the leading cause of preventable death and disease in the United States. The press release quotes CDC Director, Dr. Tom Frieden, who said that “while it is encouraging that lung cancer incidence rates are dropping in the United States, one preventable cancer is one too many.” He goes on to say, “Implementation of tobacco control strategies is needed to reduce smoking prevalence and the lung cancer it causes among men and women.” In general, Medicare covers two counseling attempts each year to help you quit smoking. Each attempt includes four sessions, meaning Medicare covers a total of eight counseling sessions every 12 months to help you quit smoking. Click here to read more about Medicare coverage of counseling sessions to help you quit smoking. Click here to read the entire press release on the CDC report. | ||
Monday, March 24, 2014
Still Smoking? Read this - there's help out there with Medicare.
Medicare Drug Restriction? Don't take "No" for an answer.
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| Volume 13 Issue 6 • March 24, 2014 | ||||||||||
What is a coverage restriction? |
Dear Marci,
Dear Chuck,I went to the pharmacy to pick up a new medication, but my pharmacist told me that there is a coverage restriction on the drug I need. What is a coverage restriction? - Chuck (Staten Island, NY) A coverage restriction is a restriction that Medicare prescription drug plans, also known as Medicare Part D plans, place on certain covered drugs to limit use of that drug. In other words, while a drug may be covered by your Part D plan, your plan may not pay for a drug you need if it has a coverage restriction.There are three types of coverage restrictions:
If your pharmacist told you that your Medicare Part D plan will not cover the drug you need, you should contact your Part D plan directly. It’s helpful to do this to find out why your Part D plan is not covering the drug you need. If the denial is due to an administrative error, it should be resolved when you call your plan. Remember to write down the date and time in which you call, the name of the Part D plan agent you speak to, and the outcome of your call. If your Part D plan is denying your drug because of a coverage restriction, contact your doctor to see if another unrestricted drug covered by your Part D plan will work for you. If your doctor cannot prescribe a different drug, ask your doctor to help you file a formal request to your Part D plan so that you can try to override the coverage restriction. This is called filing an exception request. It may also be referred to as filing a coverage determination. Filing an exception request with your Part D plan is the step you take before you can file an appeal. While plans generally provide decisions on exception requests within 72 hours, you and your doctor can request that your plan make a quicker (expedited) decision to your exception request in 24 hours if your health would be harmed by waiting the standard 72 hours for a plan decision. Keep in mind that you can file an exception request with your Medicare Part D plan, whether you get Medicare Part D through a stand-alone Part D plan that works with Original Medicare or through a Medicare Advantage Prescription Drug Plan, also known as a Medicare private health plan that provides you with Medicare prescription drug coverage. Click here to use a Medicare Interactive Roadmap that can help walk you through the necessary steps of appealing a Part D drug denial. Click here for information on the Medicare Part D appeal process. -Marci | |||||||||
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| According to a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention (CDC) earlier this year, the rate of new lung cancer cases in the United States decreased from 2005 to 2009. Specifically, the study found that new rates of lung cancer went down 2.6 percent each year among men, and 1.1 percent each year among women. The study also found that the fastest drop in new lung cancer rates occurred among adults ages 35-44 years old. The study used data from the used 2005-2009 data from the National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. According to the report’s press release, smoking continues to be the leading cause of preventable death and disease in the United States. The press release quotes CDC Director, Dr. Tom Frieden, who said that “while it is encouraging that lung cancer incidence rates are dropping in the United States, one preventable cancer is one too many.” He goes on to say, “Implementation of tobacco control strategies is needed to reduce smoking prevalence and the lung cancer it causes among men and women.” In general, Medicare covers two counseling attempts each year to help you quit smoking. Each attempt includes four sessions, meaning Medicare covers a total of eight counseling sessions every 12 months to help you quit smoking. Click here to read more about Medicare coverage of counseling sessions to help you quit smoking. Click here to read the entire press release on the CDC report. | |||||||||
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 | Medicare Interactive, a online resource developed and maintained by the Medicare Rights Center, can help you find easy-to-understand answers to your Medicare questions. Check out Medicare Interactive’s newly redesigned appeals section. The appeals section reviews how to appeal any Medicare health or drug denial. Remember, you have the right to appeal if you disagree with Medicare or your plan’s coverage decision on a health care service or item you need. | |||||||||
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