Medicare Advantage Rules Regarding Prescriptions

[rhcbp]

I was taught last year, when I was a career agent, that it was against CMS guidlines to ask a person what medications they were taking. The instructor said that this could lead to cherry picking. While it makes perfect sense to make sure a clients medications will be covered, would I be breaking the rules to inquire? If so could you send me a link on where I could find this type of information?

Thank you in advance.

 

[jdeasy]

I was taught last year, when I was a career agent, that it was against CMS guidlines to ask a person what medications they were taking. The instructor said that this could lead to cherry picking. While it makes perfect sense to make sure a clients medications will be covered, would I be breaking the rules to inquire? If so could you send me a link on where I could find this type of information?

Thank you in advance.

You were taught wrong. It is your duty to check and see if their medicines are in the formulary. How could you possibly do that if you don't ask them what they take?

 

[moonlightandmargaritas]

I was taught last year, when I was a career agent, that it was against CMS guidlines to ask a person what medications they were taking. The instructor said that this could lead to cherry picking.

The thing you've got to remember is that sometimes the "instructors" ARE instructors because they couldn't sell tea in China.

Due to that fact, they feel as though they have to become the "policy prevention" department...

 

[arnguy]

I was told the same thing as rhcbp; however, if the prospect asks you about which medications covered it is O.K. to discuss those particular medications to see if they are on the formulary. However, I will defer to Frank Stastny for a definitive answer.

 

[jdeasy]

I was told the same thing as rhcbp; however, if the prospect asks you about which medications covered it is O.K. to discuss those particular medications to see if they are on the formulary. However, I will defer to Frank Stastny for a definitive answer.

Frank is gonna tell you that it's the agent's duty to check the client's med and advise as to the best formulary. That's one reason he doesn't like to sell part D plans and recommends that they talk to their pharmacist about the best plan.

Just what companies are training you guys to not ask about the medicines? Those companies should be reported to CMS.

 

[GreenSky]

It is amazingly true. The agent cannot ask any questions about the prospect's health other than ESRD because it could be construed to be charrypicking. Asking about current medication is asking for medical information.

I agree that you cannot help someone pick a plan without knowing this information but we're dealing with the idiots from CMS.

When someone called Medicare for help, they do ask about drugs. But if an agent does it, they call it cherry picking and is illegal.

I have never written an MA or PDP without asking what drugs they take. In spite of what CMS thinks, my job is to actually help people.

Rick

 

[jdeasy]

It is amazingly true. The agent cannot ask any questions about the prospect's health other than ESRD because it could be construed to be charrypicking. Asking about current medication is asking for medical information.

I agree that you cannot help someone pick a plan without knowing this information but we're dealing with the idiots from CMS.

When someone called Medicare for help, they do ask about drugs. But if an agent does it, they call it cherry picking and is illegal.

I have never written an MA or PDP without asking what drugs they take. In spite of what CMS thinks, my job is to actually help people.

Rick

Asking about medications in relation to enrolling someone in an MA plan would be against the rules, but, to enroll or help someone enroll into a part D plan, it is an absolute must to review their medications. I was certified by CMS for 2 years to train on the regulations. I did not renew my certification for the '08-'09 AEP/OEP. I've been going over all my note since this was posted here and I cannot find such a restriction that I may have missed. In fact, we always taught agents to check meds against the formulary. I suppose I could have missed something in the cumbersome regulations and various rules by respective companies. Where would one find such a rule?

 

[Frank Stastny]

Asking about medications in relation to enrolling someone in an MA plan would be against the rules, but, to enroll or help someone enroll into a part D plan, it is an absolute must to review their medications.

Yea, what you said.

And you are correct about why I no longer "sell" Part D plans.

 

[Joe H]

Can't ask......insane but true.....but there are lots of ways to get them to ask you....show them the drug formulary, tell them about the plan and "if you are taking ANY medications..."....they will always spill their guts to tell you about what their taking, then it's ok......crazy, who at CMS comes up with this crap...probably a lawyer, who has NO background in this field......but a 21 year service rep. can ask, enroll them, and explain all the information from every plan in 1 point 2 minutes.....ya right!!

 

[captain94]

Yea, what you said.

And you are correct about why I no longer "sell" Part D plans.

Frank, What do you tell your clients to do to find a part D? I hate selling them for this reason to. I have moved to only med-supps and if I didnot have to do 1 more part D enrollment I would be happy.