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NMHC helps clients navigate the complex regulations and take advantage of new opportunities presented
by Medicare Part D.
Work with an Experienced Medicare Team
NMHC has a dedicated Medicare team with specialists in actuarial analysis, adjudication, pharmacy
networks and clinical care. We are the only PBM directly providing actuarial services for clients and one of
only a few providing Actuarial Attestation for clients applying for a Retiree Drug Subsidy from the Centers
for Medicare and Medicaid Services (CMS).
- NMHC’s Part D services for clients include:
- Helping prepare and submit applications to CMS to sponsor a Part D plan
- Assessing whether or not a plan is actuarially equivalent to Part D
- Providing assistance in applying for the Federal Retiree Drug Subsidy
- Creating Medicare formularies
- Establishing transition policies
- Contracting with the pharmacy network
- Submitting prescription drug event data to CMS
- Coordinating benefits
- Providing Explanation of Benefits (EOB) to members eligible for Medicare
Client Options
NMHC helps you understand the specific advantages and disadvantages of each Part D option available to
you. We have a comprehensive understanding of all Part D requirements and opportunities. Many of our
clients have worked with us to make successful decisions regarding their optimal course of action.
Employer Groups
Employer groups with retirees or members eligible for Medicare must accommodate Medicare Part D.
NMHC can help you choose the best option for responding to Part D requirements from a number of
alternatives. Options Include:
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Apply to become a Prescription Drug Plan (PDP) for 2007. NMHC will assist with the
application requirements and provide ongoing services to coordinate between the client and CMS,
maintain formularies and educate members. The PDP option will provide the greatest subsidy for
both non-taxable and taxable employers. Decisions to sponsor a PDP in 2007 must be made in
the first quarter of 2006.
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Apply for a Retiree Drug Subsidy. The plan will bear the costs of
prescription benefits for those eligible for Medicare. In return, they will receive a 28% subsidy
from the Federal government. NMHC can perform the Actuarial Attestation, act as the online
Account Manager, and fulfill the Cost Reporter function.
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Coordinate Benefits with Medicare. Clients keep their current plan design but define Medicare
Part D as the primary coverage. NMHC helps clients handle the complexities of following Medicare
Secondary Payment laws.
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Supplement Medicare. This is an enhancement to the Part D benefit. The plan helps cover out-
of-pocket expenses for its members who enroll in Part D. NMHC helps clients execute a
Coordination of Benefits arrangement with CMS.
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Medicare Advantage (MA) plans
MA plans adding a drug benefit are called MA-PDs. NMHC has helped MA clients prepare applications to
CMS to add a prescription drug benefit. MA-PDs are able to better manage the risk of drug spend and CMS
looks favorably on the MA-PD model because it manages both the medical and drug healthcare costs for a
Medicare beneficiary.
NMHC provides ongoing support to MA-PD clients. We stay current on all guidance issued by CMS and
provide Medicare-specific formulary management, data submission to CMS, online coordination of benefits
(COB) and other services.
Communications for Your Members
An important part of Medicare Part D is helping your members understand the decisions you are making
and how their coverage is changing under Part D, if at all.
NMHC offers specific communications and marketing materials to meet CMS requirements. These will help
ensure smooth transitions for your members and reduce the number of support calls you must handle.
For more information, please contact the NMHC Sales Department.
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