Patients will be tracking and inquiring about catastrophic coverage. How will I know how much out-of-pocket costs patients have incurred?
TrOOP (true out-of-pocket) costs will determine the start of the catastrophic coverage. Most third-party assistance, such as that from employers and unions, does not count toward the TrOOP threshold. However, contributions from State Pharmaceutical Assistance Program (SPAPs) will count towards TrOOP. It is the responsibility of the PDP to monitor TrOOP. On the retail level, there are two ways for pharmacists to monitor TrOOP on behalf of their patients: (1) through a “TrOOP facilitator” or (2) by calling 1-800-Medicare. CMS has contracted a TrOOP facilitator to monitor true out-of-pocket costs for Medicare beneficiaries. On the pharmacy level, pharmacists will need to monitor coordination of benefits (COB) for these beneficiaries to know (1) who to bill and (2) in what order to bill for these claims. One of the roles of the TrOOP facilitator is to provide pharmacists with the information needed to properly bill claims (cardholder ID number, group number, BIN, PCN, etc.) Pharmacists wil
TrOOP (true out-of-pocket) costs will determine the start of the catastrophic coverage. Most third-party assistance, such as that from employers and unions, does not count toward the TrOOP threshold. However, contributions from State Pharmaceutical Assistance Program (SPAPs) will count toward TrOOP.
Related Questions
- Patients will be tracking and inquiring about catastrophic coverage. How will I know how much out-of-pocket costs patients have incurred?
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