PDA’s Services

These actual figures for the sample Plan Sponsor show how Part D Advisors manages a Plan Sponsor’s subsidy to maximize the payment requests and get more of the money to which they are entitled from Medicare.  Every client of PDA receives a subsidy and PDA works year round to improve the amount of that subsidy and ensure the Plan Sponsor’s compliance with the regulations.  PDA maintains full legal compliance with all aspects of Medicare’s subsidy process.  In the event of an audit PDA can and will supply all necessary information requested by the Office of the Inspector General or Centers for Medicare and Medicaid Services.

Improvement Summary

Subsidy Improvement

The Medicare Part D Retiree Drug Subsidy entitles Plan Sponsors to redeem a subsidy of 28% of the money spent on eligible prescriptions for Retired Medicare Eligible Individuals enrolled in the Plan.  This means there are subsidy reimbursements available to your company if you follow Medicare’s filing instructions.

·         Full Value:  After filing for the Union’s retiree drug subsidy claims, Part D Advisors enhanced the amount and value of the Union’s 2007 subsidy collections by 39.66%, translating to $72,090.39 of the Plan’s $239,061.62 in total subsidies plus $8,336.32 in market rate interest.

·         RMEI Scouting:  PDA works with client eligibility to correct data and increase the number of approved Retired Medicare Eligible Individuals (RMEI), allowing the Plan Sponsor to receive subsidy money for the claims dispensed to these RMEIs.  This Union’s RMEIs increased from 321 to 419 (up 98 or 30.53%).  At an approximate per member subsidy of $570.55, the Plan Sponsor’s subsidy increased $55,913.90 for this year!

·         Rx Filtering:  In addition to the new members, PDA’s highly accurate drug filter offers an average boost of 2% - 5%, which increased this Union’s subsidy by $7,840.17 (3.39 %)!  Part D Advisors works only on Part D subsidy advising and can therefore offer a more accurate and complete drug filter than a Prescription Benefit Manager (PBM) or lone Plan Sponsor.  Standard drug filters used by PBM’s and other Vendors exclude many drugs actually covered by Part D depriving the Plan Sponsor of subsidies to which it is entitled. 

·         Rejection Research:  Through diligent research PDA was able to correct information for 98 of 149 members whose claims were originally denied.  These corrections allowed PDA to get the members approved by the RDS so that subsidies could be recovered for their claims.

·         Monthly Filings:  PDA files monthly subsidy payment requests where most vendors file only at year end or reconciliation. Our clients benefit by collecting market rate interest while others are waiting for reconciliation.  This plan benefited by $8,336.32 in market rate interest.  (Note:  This is compared to a single payment at the end of reconciliation.)