Attention: Pharmacy Providers DMA Guidance for Part D Denials

Recently, an issue has been identified in which Medicaid/Medicare Part D eligibility is not reflecting correctly in NCTracks. As a result, some beneficiaries in Special Assistance to the Aged, Medicaid Classification B (SAAB) and Special Assistance to the Disabled, Medicaid Classification B (SADB) eligibility groups may have lost their Part D drug coverage.

To assist Medicaid eligible beneficiaries impacted by this issue, the Division of Medical Assistance asks pharmacies to use Medicare’s Limited Income Newly Eligible Transition (NET) Program. This program allows pharmacists to enroll beneficiaries in a temporary Part D drug plan, allowing the beneficiary to receive their prescriptions with low or no co-payment. Pharmacies may refer to Medicare's Li Net Program: Four Steps for Pharmacy Providers for instructions on the use of this program.

County Departments of Social Services will provide verification of Medicaid eligibility and co-pay level.

We expect this issue to be resolved next month.

For more helpful information, visit the Best Available Evidence section on the Centers of Medicare & Medicaid Services website.