The Medicare Part D Prescription Drug Benefit program was enacted in December 2004 as part of the Medicare Modernization Act. The legislation mandated the creation of prescription drug plans for people with Medicare, along with the issuance of discount drug cards as an interim solution until the Part D benefit could take effect. CSC, as one of only 32 approved sponsors, administered a Medicare Drug Discount Card (DDC) program from April 2004 through May 2006. At its closeout, the program laid claim to the enrollment of over 450,000 Medicare beneficiaries, and the processing of over 6 million prescriptions. More importantly, CSC established a reputation as an influential presence in the pursuit and administration of Medicare pharmacy programs. (See related case study)

The DDC effort was an essential building block to CSC’s long-term success in the Medicare pharmacy programs, as it was the interim benefit bridging beneficiaries to the Medicare Part D drug program that was launched in January 2006. CSC was strategically positioned to function as a subcontractor to MemberHealth, and collaboratively, the Community Care Rx^SM prescription drug plan was implemented nationwide. CSC holds the responsibilities of building and managing the IT infrastructure supporting the enrollment, claims processing, and communications operations of the entire program, as well as supporting key management functions. In all, as a result of leveraging relationships developed during the DDC program, five team members partnered together to provide Medicare Part D prescription drug coverage:

1. MemberHealth (MHRx)
   
   • Nationwide pharmacy network with 57,000 participating providers
     
   • The prime contractor with CMS
   
   
2. Computer Sciences Corporation (CSC)
   
   
3. The National Community Pharmacists Association (NCPA)
   
   • Represents the pharmacist owners, managers, and employees of nearly 25,000 independent community pharmacies (more than 60,000 pharmacists) across the U.S.
     
   • Provided the CCRx brand name
   
   
4. Community Care Rx (CCRx)
   
   • A subsidiary of NCPA
     
   • Implements the medication therapy management services (MTMS) program.
     
   • CCRx is a recognizable brand to the consumer.
   
   
5. Ameri-Life
   
   • Largest Medicare Supplement carrier in the country
     
   • Responsible for marketing CCRx and helping to enroll new members

The CSC Medicare Part D Program Director is Andy Anderson, and the CSC Program Manager for the Part D program is Ed Linhares. CSC’s IT infrastructure management is headquartered in Hanover, MD. CSC’s IT solution to processing the enrollments of millions of Medicare beneficiaries and the prescription claims transmitted from thousands of pharmacies across the country, lies in a sophisticated network of automated, customized edit processes, as well as interfaces among the CCRx enrollment system, claims processing system, and CMS’ processing status in the form of weekly Transaction Reply Reports (TRRs).

CSC worked with MemberHealth to carefully create a plan benefit design that would best serve the prescription needs of Medicare beneficiaries at varying degrees of income and health. As a result, CCRx offers three benefit plans, briefly described as:

CCRx Basic. This plan has the lowest monthly premium and a $0 co-pay for generic drugs during the deductible and initial coverage period. In 2007, generic drugs will not have a deductible. The co-payment and coinsurance structure will also change, including a decreased coinsurance percentage for 90-day drug supplies.

CCRx Choice. This plan provides for a mid-range premium and has no deductible for brand or generic drugs, so coverage begins immediately. In 2007, there is no deductible, and generic drugs have a $0 co-payment.

CCRx Gold. This plan offers a $0 deductible, so coverage begins immediately. This plan has a low, flat-dollar co-pay for preferred brands and a percentage of coinsurance for specialty drugs. A low-dollar co-pay continues for generics during the coverage gap in this enhanced plan. CCRx Gold is an ideal plan if you take several prescription drugs. In 2007, there is no deductible, and a $5 co-payment for tier 1 generic drugs during the Coverage Gap Phase.

CSC’s objective for the Community Care Rx benefit plan is to contribute to the enrollment of 2.5 million Medicare beneficiaries by the end of 2006, through accessing current DDC members prior to 2006 program start, and taking advantage of CMS auto enrollments prior to the 2006 program start. CSC was able to leverage both as part of a comprehensive and sophisticated marketing initiative, highlighted by the following key concepts:

• Publishing direct mailings to the CCRx enrollees that were receiving benefits through the DDC in order to attract approximately 250,000 members
  
• Pricing the plan designs in such a way as to qualify for the auto enrollment program of dual eligibles (beneficiaries receiving both Medicare and Medicaid coverage), in order to acquire approximately 500,000 members through this program
  
• Producing pre-enrollment material for availability to interested parties at community-based pharmacies throughout the country. Though community pharmacies were not allowed to market the CCRx plan specifically, availability of the material upon inquiry was expected to generate approximately 250,000 members.

As of today, CMS has confirmed the enrollment of over 1 million beneficiaries to the CCRx plans.

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Related Information

Learn about CSC's support for the Medicare Helpline Reference Center, which was instrumental in supporting the rollout of Medicare Part D.

Read more about CSC's support for the Centers for Medicare and Medicaid Services.