At the start of each year, the Centers for Medicare and Medicaid Services (CMS) implement changes to their regulations and guidelines.

The updates for 2017 incorporate a number of modification that directly affect our customer facilities and the residents they serve.

CMS awards a “Benchmark Status” to Part D plans that meet specific criteria. Beginning January 1, 2017, following plans have received “Benchmark Status” and the premium is paid in full by Extra Help if the member also receives full Medicaid benefits:


  • Aetna Medicare Rx Saver
  • Cigna-Healthspring Rx Secure
  • EnvisionRxPlus
  • Humana Preferred Rx Plan
  • SilverScript Choice
  • Symphonix Value Rx
  • WellCare Classic

In order to modify their situation, Medicaid recipients can enroll in a new Part D plan anytime they wish.

Additionally, for Medicaid recipients who were receiving $2.95 copays for generics and $7.40 for brands, copays have increased for 2017. These residents will now have $3.30 generic and $8.25 brand copays.

Other CMS mandated 2017 modifications include an increase of the maximum deductible from $360 to $400 and a reduction of out-of-pocket expenses during the “donut-hole” period (the time between satisfaction of copays and reaching maximum out-of-pocket costs) to 51% of insurance adjusted cost for generics and 40% of insurance adjusted cost for brands. Over the next three years, “donut-hole” out-of-pocket costs are scheduled to decrease further.

Billing experts at Southern Pharmacy are available to answer your questions or clarify any issues related to CMS standards and your prescription related costs. Call us at 1-866-768-8479 and select the Billing option.