Medicare Part D Marketing Guidelines
What are Medicare-approved Prescription Drug Plans permitted
? Call potential enrollees directly.
? ? ? Plans must honor national and state “do not call” lists, as well as individual
requests to not be called again.
? ? ? Plans are allowed one or two follow-up calls if they do not reach potential
enrollees the first time. If they still do not reach them after the third attempt,
plans cannot follow up again for six months. ? Send direct mail to potential enrollees.
? ? ? As with phone calls, plans are allowed one or two follow-up letters if they
do not reach potential enrollees the first time. If they still do not reach them
after the third attempt, plans cannot follow up again for six months.
? Enroll people online.
? Visit potential enrollees at their homes.
? ? ? Plans are only allowed to visit a potential enrollee after they have obtained
his/her expressed permission to do so. ? Offer beneficiaries or potential beneficiaries an abridged formulary.
? ? ? Plans can also answer formulary questions with answers specific to a
beneficiary’s medication needs. If a beneficiary asks for a formulary, for
convenience a plan representative can, for convenience, obtain information
just for the drugs that the beneficiary in question takes.
? ? ? If, however, the beneficiary asks for a comprehensive formulary, the plan is
required to send it to him/her.
? Conduct sales presentations in a provider’s place of business (pharmacy,
doctor’s office, long-term care facility).
? ? ? The presentation must take place in a common area, however. If the
presentation is in an area that is at all restricted, it may be an improper
action. (See: Center for Medicare and Medicaid Services (CMS)
MARKETING MATERIALS GUIDELINES, p. 127)
What are Medicare-approved Prescription Drug Plans NOT
permitted to do?
? ? ? Enroll beneficiaries over the phone during a solicitation call.
? ? ? Plans can, however, enroll beneficiaries if they have called the plan with
the explicit purpose of enrolling.
? ? ? Initiate a request for a house visit.
? ? ? A plan representative can respond to a request for a house visit, but s/he
cannot ask to do so.
? ? ? If s/he does ask to visit a beneficiary at home before the beneficiary
inquires about a home visit, or if s/he implies that any plan info can only
be distributed during a home visit, s/he is acting improperly. (See CMS
MARKETING MATERIALS GUIDELINES, p. 69)
? ? ? Solicit members or market any of their plans door-to-door.
? ? ? Refuse an explicit request for a comprehensive formulary.
? ? ? Process any enrollment applications before November 15, 2005.
? ? ? Plans can accept enrollment applications before November 15, however.
What are providers permitted to do?
? ? ? Distribute and/or make available plan marketing materials.
? ? ? Providers can display posters for different plans.
? ? ? They can also make available PDP enrollment applications.
? ? ? They cannot, however, make available MA-PD (or MA) enrollment
? ? ? Provide patients with information about different plans’ benefits
? ? ? Educate patients on what the kind(s) of plan(s) that would be best for them.
? ? ? Providers cannot advocate for, or steer any patients towards, any one plan
or group of plans. They can only educate.
? ? ? Allow presentations by plan representatives in their places of business.
? ? ? The provider must ensure that the presentation is in a common area with
open access to anyone who wants to attend.
? ? ? The provider must ensure that the presentation does not take place
anywhere health care services are provided, such as behind a pharmacy
? ? ? If access to the presentation is at all restricted in any way, the presentation
may be improper. (See: CMS
MARKETING MATERIALS GUIDELINES, p. 127)
What are Providers NOT permitted to do?
? Accept any enrollment applications.
? Rank order or highlight any of the plans they discuss.
? Advocate for any particular plan or group of plans.
? ? ? Any phrases such as, “You should enroll in this plan,” or “I use this plan
and I think it would be good for you too,” are strictly prohibited.
? ? ? Any hint or implication that a doctor is outwardly favoring any one plan
over any other – apart from offering plain factual evidence about plan
benefits that correspond with patients’ drug needs – is strictly prohibited.
How to report potentially improper conduct If you think, or have reason to believe, that a prescription drug plan and/or a provider
may have been acting improperly, you may want to report their activities. Below are
some key contact information for persons and organizations that deal with Medicare
fraud, waste, and abuse.
Theresa Linkowich is the CMS point-person for reporting potentially improper conduct
through November 15.
She can be reached at (410) 786-9249, or at Theresa.Linkowich@cms.hhs.gov.
After November 15, CMS will be handling any cases of potentially improper conduct
through eight different private contractors called Medicare Rx Integrity Contractors
(MEDICs). HAP will provide contact information for the MEDICs when it is available.
Senior Medicare Patrols
SMPs are organizations in every state whose purpose is to locate and report potential
fraud or abuse.
Find your local SMP at: http://www.aoa.gov/smp/grantee/grantee_state.asp