GIS 14 MA/05: Medicare Coverage of Barbiturate Medications

This General Information System (GIS) message is to inform local departments of social services of changes to the fee-for-service and managed care pharmacy benefit for full benefit Medicare/Medicaid dual eligibles.

Effective January 1, 2014, Medicare will cover barbiturates for any medically accepted indication. Therefore, effective January 1, 2014, the Medicaid program will no longer cover barbiturates prescribed for any condition when billed for full benefit Medicare/Medicaid dual eligibles. These drugs will be billed directly to the beneficiary's Part D plan or, when applicable, to Medicare Part B.

The New York Medicaid Program will continue to cover certain drugs which are excluded from the Medicare Part D benefit, such as some prescription vitamins and some non-prescription drugs. These drugs will continue to be billed directly to Medicaid.

Local Districts may receive phone calls from dual eligibles in need of Medicare Part D covered medications, who have disenrolled themselves from a Medicare Part D plan. Dual eligibles should be reminded that enrollment in Medicare Part D is a Medicaid eligibility requirement. The dual eligible individual must contact Medicare at 1-800-Medicare to request enrollment in a Part D plan. Enrollment into a Part D plan is prospective. However, the dual eligible will be able to use the Limited Income Newly Eligible Transition (LI NET) program to get their Part D medications. The pharmacy can temporarily fill medications with LI NET using the beneficiary's Medicare red, white, and blue card and his or her Common Benefit Issuance Card (CBIC) until the beneficiary's Medicare D plan goes into effect.

Beneficiaries can contact Medicare at 1-800-MEDICARE for information regarding Medicare drug benefits. If assistance is required choosing a different plan or there are questions related to Part D plans, beneficiaries should contact 1-800-MEDICARE (1-800-633-4227) or 1-877-486-2048 for TTY users. Assistance is also available through the New York Health Insurance Information Counseling & Assistance Program (HIICAP) at 1-800-701-0501.

Questions pertaining to Medicaid fee-for-service drug coverage can be directed to the Office of Health Insurance Programs, Bureau of Pharmacy Policy and Operations at (518) 486-3209.