Opting out of Medicare Part D

People that are deemed dual-eligible are automatically enrolled in a Medicare PDP.  Some people may choose to disenroll, or opt out, from their PDP, meaning the person has chosen to not participate in the Medicare Part D plan. Medicaid is not liable for the person’s prescription drug coverage if the person opts out of enrolling in a Part D plan.

The VDP pharmacy claims system returns a message on paid claims for people that will soon become eligible for Medicare Part D.  This message will be returned several months prior to the person’s Medicare coverage effective date to alert the pharmacy that Medicare will become liable for prescription drug coverage. The message is returned in the "Additional Message Information" field (526-FQ) and read "Part D liable for this client's Rxs no later than XX/XX/XXXX".

Pharmacy providers should advise the person that Medicaid will no longer pay for prescriptions for Part D covered drugs as of the date returned in the message. The person must choose a Medicare Part D plan by that date in order for their prescription benefits to continue.  After the date returned Medicaid will only be responsible for the Part D-excluded wrap-around drugs.