Document 6504704

HOW TO SAVE ON
PRESCRIPTION DRUGS
The AIER Guide to Prescription Drug
Assistance Programs for Seniors
By
Kerry A. Lynch
ECONOMIC EDUCATION BULLETIN
Published by
AMERICAN INSTITUTE for
ECONOMIC RESEARCH
Great Barrington, Massachusetts
ECONOMIC EDUCATION BULLETIN
Vol. XLIII No. 8 August 2003
Economic Education Bulletin (ISSN 0424-2769) (USPS 167-360) is published once a
month at Great Barrington, Massachusetts, by American Institute for Economic Research,
a scientific and educational organization with no stockholders, chartered under Chapter
180 of the General Laws of Massachusetts. Periodical postage paid at Great Barrington,
Massachusetts. Printed in the United States of America. Subscription: $25 per year.
POSTMASTER: Send address changes to Economic Education Bulletin, American Institute for Economic Research, Great Barrington, Massachusetts 01230.
INTRODUCTION
C
ONGRESS may or may not create a new prescription drug benefit
to add to Medicare, the Federal healthcare program for the elderly
and the disabled. Even if a bill passes, the new benefit probably
will be phased in over a period of months or years. In the meantime,
Medicare beneficiaries must find other ways to pay for prescription drugs.
Some seniors have prescription drug benefits through their previous employers or through "Medigap" insurance plans. However, many do not, or
their benefits are limited.
If you lack adequate insurance coverage, there are a number of ways to
reduce your prescription drug outlays. Chief among these are the assistance programs offered by states and drug manufacturers. This booklet
provides a summary of them.
Currently, 39 states have established or authorized some type of assistance. The programs are a hodgepodge of eligibility rules and benefits (see
pp. 4-26 for details). Even if you do not need any help paying for prescription
drugs, the different provisions of these plans offer lessons in how a welldesigned, affordable prescription drug benefit for Medicare might work.
Some states cast a broad net, offering benefits to anyone age 65 or older.
Most, however, target only needier people by offering assistance only to
seniors with incomes below a certain threshold, and a few states require an
asset test. However, the resource caps are higher than those for Medicaid,
the health program for poor people that is jointly financed by the Federal
and state governments. Some programs cap the maximum benefits they
will provide to each participant—which keeps costs down but leaves individuals exposed to the risk of catastrophically high prescription drug costs.
Others limit "first dollar" benefits but cover most or all costs that exceed a
certain threshold.
Some plans require participants to pay only a small fee of $5 or $10 for
each medication. This helps neediest seniors the most, but it can be quite
expensive for the state. Alternatively, a growing number of states are
offering discount cards, which enable participants to buy drugs at a discounted price. These discount programs are less expensive for the states,
which negotiate the price discounts with drug manufacturers and pharmacies. Because the costs are low, the programs can help more seniors, including moderate and higher-income people. However, the discounted prices
may still be unaffordable for those with lower incomes. The discounts also
vary widely, depending on the state and the drug. Moreover, there is a risk
that as more states create these discount card programs, the drug compa1
nies may limit their discounts or raise their prices to offset them, or pharmacies may refuse to participate.
All these programs are subject to change. States are under pressure to
provide more assistance to seniors. At the same time, fiscal pressures and
rising drug costs have led some states to cut their benefits by tightening
their eligibility rules and requiring beneficiaries to pay a higher portion of
their prescription drug costs. Some programs have been frozen or their
launch has been delayed due to budget constraints. Others may be postponed or suspended due to legal challenges.
In addition, the eligibility rules for many programs change automatically each year. In plans with income limits, the income amounts usually
are tied to the Federal Poverty Guidelines, which increase slightly each
year. (In 2003, the poverty guideline is $8,980 for an individual, up from
$8,860 in 2002, and for couples it is $12,120, up from $11,940). Even if
your income is too high to qualify you for a program now, you may qualify
in the future.
We have tried to provide accurate and up-to-date information, but you
should contact your state for recent changes and further details. Many of
the 800 numbers we have listed are surprisingly helpful. So are the state
websites. Their sections on "Frequently Asked Questions" often answer
questions more clearly than any brochure or individual could. If you do not
have access to the Internet, ask a relative or friend who does. If you give
them the website address they can find and print information for you.
Another benefit of websites is that anyone can access them regardless of
where one lives, while the 800 numbers often work only inside each state.
You can also get additional information from local senior centers or
social welfare offices. Your physician and your pharmacist also may know
about programs offered by your state or other sources. Most programs
require you to fill out an enrollment form, and these are often available at
senior centers, state offices, and drugstores.
If your state does not offer a prescription drug program, or you are not
eligible for it, or you would like additional help paying for your drugs, you
have other options. Some pharmaceutical companies offer discount plans.
We have provided a list of selected programs and contact information (pp.
27-29). If the manufacturer of your drugs is not listed, ask your pharmacist
for information on any available plan and how to contact the company.
Some drugstores offer their own discount cards. Although some state programs require that you have no prescription drug insurance to qualify for
them, they often do not count these company discount cards as insurance.
Veterans may be eligible to join the Veterans Health Care System. The
rules for eligibility have changed in recent years, and they changed yet
again in January 2003. We have included a summary of the VA program
(pp. 30-31).
Canada is also a source of cheaper prescription drugs for a growing
number of Americans. It is currently illegal to import prescription drugs,
but nonetheless cross-border sales reportedly have increased to as much as
$650 million. Some people travel to Canada to buy the drugs but many
more buy them from Internet pharmacies. The House of Representatives
recently voted to legalize the importation of prescription drugs, but this bill
has not yet become law. At the same time, the major drug manufacturers
are threatening to take action to stop such imports, for example by limiting
shipments of their drugs to Canadian pharmacies. As with so much of the
healthcare system, the market for imported drugs is in a state of flux.
If Congress passes a Medicare prescription drug bill and President Bush
signs it, the rules of the game will change for all seniors. States will modify
their own plans. They may drop them or revamp them to fill holes left by
any new Medicare coverage. Check with your state to find out about any
such changes.
Finally, there are steps you can take to reduce your prescription drug
costs even if you are not eligible for any assistance. Always ask your
doctor if there is a generic substitute for a brand-name drug. Ask your
doctor for free samples. Before filling a prescription, shop around and
compare prices at different pharmacies. If you have a regular pharmacy but
find a lower price elsewhere, ask if yours will match it.
Ask if there is a less costly way to fill your prescription. Sometimes the
price of a 40 mg pill is the same or only slightly higher than the price of a
20 mg pill. If your prescription calls for the 20 mg pill, you may be able to
buy the 40 mg pill for roughly the same price and cut it in half. This is safe
with many but not all pills; ask your doctor and pharmacist first. Check to
see if you can get your prescriptions filled at less cost through mail-order
plans, such as those offered by health insurance companies, AARP, and
drug retailers.
Enrollment rates in the drug assistance programs offered by the states
and by drug companies often have been lower than expected. There may be
any number of factors that have kept eligible people from signing up, but
probably many seniors simply do not know what is available. We hope this
booklet will be a useful antidote to this lack of information.
STATE PROGRAMS
Alaska
• There are no State Assistance Programs that offer prescription
drug coverage in Alaska.
Alabama
SenioRx Partnership for Medication Access
• Phone number: 1-800-243-5463
• State website: www.ageline.net/seniorrx.htm
• What is covered: Drugs made by participating pharmaceutical companies.
• Who is eligible: Residents age 60 or older with chronic
medical conditions who do not have prescription insurance
coverage. Annual income must be below 200 percent of the
poverty level: in 2003, $17,960 for a one-person household,
$24,240 for two people, and $30,040 for three people.
• How it works: This new program was scheduled to begin in
July 2003. It is a partnership of state agencies and community organizations designed to assist seniors with applying
for drug assistance programs provided by pharmaceutical
manufacturers.
Arizona
Prescription Drug Program
•
•
•
•
Phone number: 1-888-227-8315
State website: www.rxamerica.com
What is covered: Prescription drugs.
Who is eligible: Residents who are enrolled in or eligible
for Medicare.
• How it works: You present a discount card when you buy
prescriptions and receive a discount ranging from five to 50
percent off the retail price. Discounts depend on the drug
and the participating pharmacy. There is an annual enroll-
ment fee of $9.95. This program was scheduled to begin in
June 2003 but has been delayed indefinitely by lack of
funding.
Arkansas
• Arkansas passed a law in 2001 to create a prescription drug
coverage program but its launch has been postponed due to
lack of funding.
California
Prescription Drug Discount Program
•
•
•
•
•
Phone number: 1-800-434-0222
State website: www.cahealthadvocates.org
What is covered: Almost all prescription drugs.
Who is eligible: Anyone with a Medicare card.
How it works: Go to any pharmacy that accepts Medi-Cal
(California's Medicaid program) to purchase prescriptions
at the discounted Medi-Cal rate. You pay for the prescription yourself but get a discounted price. There is a 15 cent
processing fee for each prescription. You do not have to be
in Medi-Cal. You must present your Medicare card to the
pharmacy. A revised plan called the Golden Bear Discount
Program was enacted in 2001 but has not yet begun.
Connecticut
Pharmaceutical Assistance Contract to the Elderly and Disabled Program (ConnPACE)
• Phone number: 1-800-423-5026 (in Hartford call 1-860832-9265)
• State website: www.connpace.com
• What is covered: Most prescription drugs and insulin
supplies.
• Who is eligible: Must be age 65 or older, or 18 or older and
disabled, and a resident for at least six months prior to
applying. Medicaid enrollees are not eligible. People
covered by other insurance plans may be, depending on
their plan's drug benefit. Income eligibility amounts increase each year with Social Security cost-of-living adjustment. In 2003, income must be $20,300 or less if single,
and $27,500 or less if married.
• How it works: You pay $16.25 for each prescription. Generic drugs must be substituted for brand-name drugs
unless a physician requests otherwise. There is a $30
annual registration fee. Annual renewal is required.
Colorado
• There are no State Assistance Programs that offer prescription drug coverage in Colorado.
Delaware
Prescription Assistance Program
• Phone number: 1-800-996-9969
• State website: www.state.de.us/dhss/dss/prescription.html
• What is covered: Medically necessary prescription drugs.
Does not cover diabetic drugs or supplies.
• Who is eligible: Residents who are age 65 or older or
qualify for Social Security disability benefits. They must
not be eligible for Medicaid, have other insurance that
covers drugs, or be eligible for the Nemours program.
Individuals must have incomes less than 200 percent of the
Federal poverty level (currently $1,477 gross monthly
income per person; couples are counted as two individuals)
or have prescription costs that exceed 40 percent of their
income.
• How it works: You pay $5 or 25 percent of the cost of each
prescription, whichever is greater. If your annual income is
less than $12,500 (single) or $1.7,125 (married) you may be
eligible for the Nemours program, a private initiative. For
more information, call 1-800-292-9538 or 1-302-651-4405.
Florida
Silver Saver Program
• Phone number: 1-888-419-3456
• State website: www.floridahealthstat.com/silversaver.shtml
• What is covered: All prescriptions approved by Florida
Medicaid.
• Who is eligible: Residents age 65 or older who are eligible
for Medicare. Part Two requires incomes between 88 to 120
percent of the Federal poverty level guidelines (in 2003,
$679-$9l8 per month for singles, and $9O8-$ 1,232 for
married couples).
• How it works: Under Part One of the program, anyone on
Medicare can go to a pharmacy that participates in Medicaid, present their Medicare card and proof of Florida
residency, and get a discount on their prescription drugs.
You may only use this program if you have no prescription
drug insurance, or you have reached your coverage limit, or
your plan does not cover a particular drug, or you have a
deductible to meet. Under Part Two of the program, the
state pays up to $160 per month toward prescriptions. Each
month $160 is placed in your Silver Saver Account, and
when you use your card at a participating pharmacy the
price (less a copayment) is automatically deducted from the
account. Copayments are $2 for generic drugs, $5 for
brand-name drugs on a preferred list and $15 for other
drugs.
Georgia
• There are no State Assistance Programs that offer prescription drug coverage in the state of Georgia.
Hawaii
Hawaii passed a law in 2002 to create a prescription drug
coverage program but it is not yet operational. One part
would provide a discount card to all residents of the state.
Another part would extend Medicaid prescription drug
coverage to some people with incomes too high to qualify
for Medicaid.
Idaho
• There are no State Assistance Programs that offer prescription drug coverage in the state of Idaho.
Illinois
Circuit Breaker and Pharmaceutical Assistance; SeniorCare
• Phone number: 1-800-226-0768
• State website: www.revenue.stae.il.us/CircuitBreaker and
www.seniorcareillinois.com
• What is covered: Various prescriptions and prescribed overthe-counter drugs, depending on which program you join.
• Who is eligible: Residents age 65 or older, or age 16 or
older and totally disabled. Widows and widowers who were
63 or 64 when their spouse died are eligible if their spouse
was eligible before death. Income must be less than
$21,218 (in 2002) if you are applying for yourself; $28,480
or less for if two qualified residents are applying, and
$35,70 or less if three are applying. People on MediPlan
(the state Medicaid program) are not eligible, but people
with insurance that covers drugs may be.
• How it works: Applicants submit Form IL-1363 and the
state then determines which of two programs they qualify
for, SeniorCare or Pharmaceutical Assistance, depending
on their income. For the SeniorCare program, you receive a
membership card. If your income is less than $8,879 per
year ($12,119 for couples), the card pays up to $1,750 per
person for covered drugs. After that, you make a 20 percent
copayment for each prescription. If your income is above
these thresholds, but below $17,960 for singles or $24,240
for married couples, the card pays the first $1,750 of drug
costs and you pay $1 for each generic and $4 for each
brand-name drug. After the limit is reached, you also pay
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20 percent for each prescription. If you request a brandname drug over an equivalent generic, you pay the difference in price. Alternatively, you can enroll in the
SeniorCare Rebate program, in which you get a $25 rebate
check every month instead of a SeniorCare Card. All
programs require annual renewal. For seniors who failed to
reapply for SeniorCare by this year's June 30 deadline,
coverage has been extended through September 30, after
which it ends unless you reapply. Beginning in January,
all seniors and the disabled can sign up for a new prescription drug discount card that will cost $25 per year
but have no income restrictions. They will pay discounted
prices negotiated by the state with drug companies.
Indiana
HoosierRx
•
•
•
•
Phone number: 1-866-267-4679
State website: www.state.in.us/fssa/hoosierrx
What is covered: Prescription drugs covered by Medicaid.
Who is eligible: People age 65 or older who have been
residents for at least 90 days out of the past 12 months.
Monthly income must be 144 percent of the Federal poverty limit or less (in 2003, $1,011) if single, or 135 percent
of the limit or less (in 2003, $1,364) if married. Those with
drug coverage through an insurance plan or Medicaid are
not eligible.
• How it works: You present a discount card to pharmacies
and receive a 50 percent discount on prescription drug
costs, up to a yearly cap that varies with income. If your
monthly income is $1,011 or less ($1,364 for married
couples), the cap is $500 per year per person. If your
income is $898 or less ($1,212 for couples), the cap is
$750. If your income is $749 or less ($1,010 for couples),
the cap is $1,000. After your benefit exceeds the cap, you
may still use the card to receive small discounts on prescriptions.
Iowa
Priority Prescription Savings Program
•
•
•
•
Phone number: 1-866-282-5817
State website: www.iowapriority.org
What is covered: All prescription medications.
Who is eligible: Residents who are eligible for Medicare.
There are no income requirements. Medicaid recipients are
not eligible.
• How it works: There is a $20 annual membership fee.
Enrollees receive a discount card to present to participating
pharmacies. Discounts vary by prescription. The program
is offered by the not-for-profit Iowa Prescription Drug
Corporation, which negotiates discounted prices with
pharmaceutical companies.
Kansas
• Phone number: 785-296-4986
• State website: www.agingkansas.org/kdoa/programs
• What is covered: Prescription drugs that treat chronic (not
acute) illness, and diabetic supplies not covered by Medicare. Over-the-counter and lifestyle drugs are not covered.
• Who is eligible: Residents age 65 or older with incomes of
less than 135 percent of the Federal poverty level (in 2003,
$12,123 for single persons, $24,240 for married couples),
who are not covered by private prescription drug insurance
(prescription discount cards do not count), are not eligible
for any other government prescription drug programs such
as Medicaid or VA benefits, and have not voluntary canceled any prescription drug coverage within six months of
applying to this program.
• How it works: You are reimbursed for some of your drug
costs. Once the state determines that you are eligible, it
sends you an application for reimbursement. You return this
form by a set date, along with a pharmacy list of all drugs
purchased during a given period (typically, each quarter).
Reimbursement applications were accepted in September
10
2002, January 2003, and April 2003; check with the Kansas
Department of Aging for the current schedule. You are
reimbursed for up to 70 percent of your out-of-pocket costs.
The maximum reimbursement is $1,200 per person per
year.
Kentucky
• There are no State Assistance Programs that offer prescription drug coverage in the state of Kentucky.
Louisiana
• Louisiana passed a law in 2003 to create a prescription drug
coverage program but it is not yet operational. It is designed to help seniors with incomes below the Federal
poverty level ($8,980 for a single person in 2003).
Maine
Low Cost Drugs for the Elderly or Disabled Program; Maine
Rx Plus Program
• Phone number: 1-866-796-2463
• State website: www.state.me.us/dhs/beas
• What is covered: For the Low Cost Drugs program, all
generic drugs plus brand-name drugs that are used to treat
many conditions.
• Who is eligible: For the Low Cost Drugs program, residents
who are age 62 or older, or 19 years or older and disabled.
Household income must be less than 85 percent of Federal
poverty level ($1,365 per month for one person, $1,840 for
two, in 2002). If you spend 40 percent or more of your
income on prescription drugs, the income limits are 25
percent higher.
• How it works: In the Low Cost Drugs program, you pay 20
percent of the cost of the drug or $2, whichever is greater.
For drugs that are not covered, small discounts (about 10
percent) may be available. If you pay more than $1,000
11
out-of-pocket for drugs in a year, catastrophic coverage
may be available. You must reapply every year. In January
2004 the Maine Rx Plus Program is scheduled to begin.
After much legal wrangling it was cleared for operation by
the Supreme Court in May. It will allow beneficiaries to
buy drugs at a discount. The state may also set price caps
on some drugs. The program will be open to Maine residents of any age with incomes below 350 percent of the
Federal poverty level.
Maryland
Maryland Pharmacy Program (MPP)
1. Maryland Pharmacy Assistance Program
• Phone number: 1-800-492-1974 or 1-800-226-2142
• State website: www.dhmh.state.md.us/mma
• What is covered: All medically necessary prescription
drugs that are covered by the Maryland Medical Assistance
Program (the state's Medicaid program), which covers
more than 100,000 drug products.
• Who is eligible: Permanent residents of any age with (in
2003) incomes at or below $869 per month ($1,010 for
couples) and with assets (excluding a home) below $4,000
($6,000 for a couple). Eligibility lasts for 12 months.
• How it works: You pay from $2.50 to $7.50 for each prescription. There is no enrollment fee.
2. Maryland Pharmacy Discount Program
• Phone, website, and coverage: Same as above.
• Who is eligible: People on Medicare who have monthly
incomes below 175 percent of the Federal poverty level
($1,310 for an individual and $1,768 for a couple in 2003).
There is no asset test. You must have no other prescription
drug insurance.
• How it works: The State pays a discounted price for most
medications. You pay 65 percent of the state's discounted
12
price, plus a $1 processing fee. There is no enrollment fee.
3. Senior Prescription Drug Program
•
•
•
•
Phone: 1-800-972-4612
Website: Same as above
What is covered: Most prescription drugs.
Who is eligible: Anyone on Medicare with income below
300 percent of the Federal poverty level ($26,940 for an
individual and $36,360 for a couple in 2003). Must have
no other prescription drug benefits.
• How it works: This is a prescription drug insurance plan
subsidized by the state but managed by a private company,
CareFirst BlueCross Blue Shield. You pay a monthly $10
premium and $10 for each generic drug, $20 for each
brand-name drug on a preferred list, and $30 for drugs not
on the list. The maximum benefit is $1,000 per year.
Massachusetts
Prescription Advantage
• Phone number: 1-800-243-4636
• State website: www.800ageinfo.com/Programs/pa.cfm
• What is covered: Prescription drugs that are listed in a
formulary.
• Who is eligible: Residents age 65 and older; younger
residents who meet income and disability guidelines. Not
open to people who are eligible for Medicaid. Enrollment
was closed in February 2003 due to budget cuts, but funds
were restored as of July 1 and enrollment will reopen.
• How it works: Premiums, deductibles, and copayments are
based on annual household income. If your income is
below $16,883 if single or married with only one spouse in
plan, or $22,786 if married and both are in plan, your
premiums and deductibles are zero. (See website for the
rest of the new rate schedule that is effective October 1,
2003.) Once your out-of-pocket outlays for deductibles
and copayments reach an annual limit (either $2,000 for
13
one person in plan and $3,000 if both spouses are in plan,
or 10 percent of income, whichever is less) the plan covers
all copayments for the rest of the year. In fiscal year 2004
the program is subject to change if its funds run short.
Michigan
Elder Prescription Insurance Coverage (EPIC)
• Phone number: 1-866-747-5844
• State website: www.miepic.com
• What is covered: Most prescription drugs, including diabetic supplies. Drugs not considered essential, such as
cosmetic drugs, are not covered.
• Who is eligible: Due to the state's fiscal problems, enrollment is currently closed except for Emergency Coverage.
Emergency coverage for 45 days is available to all eligible
seniors: those who are 65 or older, have been a resident for
three months, and have a household income less than 150
percent of the Federal poverty limit (in 2003, $13,470 for
one person or $18,180 for two), and have no prescription
drug coverage through Medicaid or other insurance. In
addition, emergency coverage requires that prescription
costs equal a minimum percent of monthly income, and a
doctor must certify that they are required to meet a medical
emergency. Emergency applications must be submitted
through a local Senior EPIC center.
• How it works: Your copayment for each drug depends on
your income but will not exceed 20 percent of the drug's
total cost. Brand-name drugs may cost an additional $15
each. There is a maximum annual copayment. There is a
$25 annual fee and enrollment must be renewed each year.
Minnesota
Prescription Drug Program
• Phone number: 1-800-333-2433
• State website: www.dhs.state.mn.us/healthcare/asstprog/
prescription_drugs.htm
14
• What is covered: Most prescription drugs.
• Who is eligible: Medicare enrollees age 65 and older, or
under 65 with a disability, who have been residents for six
months. Must not be eligible for full Medical Assistance
(the state Medicaid program) or have had prescription drug
coverage within four months of applying. Must be enrolled
in the Qualified Medicare Beneficiary or the Service
Limited Medicare Beneficiary programs that help people
pay out-of-pocket Medicare costs. There are income and
asset tests. Income must be less than 120 percent of the
Federal poverty guidelines, currently $918 per month for
one-person household, $1,232 for two people, and $1,546
for three people. Total assets, excluding a home, a car, and
a burial fund, may not exceed $10,000 for one person, or
$18,000 for two or more people.
• How it works: The program pays for most prescription
drugs after enrollees pay the first $35 per month (per
person).
Mississippi
• There are no State Assistance Programs that offer prescription drug coverage in the state of Mississippi.
Missouri
SenioRx
•
•
•
•
Phone number: 1-866-556-9316
State website: www.missouriseniorx.com
What is covered: Most prescription drugs.
Who is eligible: Must be age 65 or older and a resident for
the at least 12 months. Recipients of Medicaid, VA drug
benefits, or drug insurance that is equal to or better than
this program are not eligible. Income must be below
$17,000 for an individual and $23,000 for maflied couples.
• How it works: Open enrollment for 2003 was held from
January 1 to February 28, for plan year that runs from July
1, 2003 through June 30, 2004. If you were not eligible
15
during the enrollment period because of age, you may
apply 30 days before or after your birthday. Seniors with
incomes up to $12,000 per year ($17,000 for married
couples) must meet a $250 deductible and pay a $25 enrollment fee per person each year. Those with higher incomes
have a $500 deductible and a $35 fee. Enrollees pay 40
percent of the cost of each prescription, plus the cost
difference between brand-name and equivalent generic
drugs. The maximum benefit is $5,000 per enrollee per
year. Annual enrollment is required.
Montana
Montana passed a law in 2003 to create a prescription drug
coverage program but it is not yet operational. Scheduled to
begin in 2004, it will provide price discounts to people who
are age 62 and older, or 18 and older and disabled. Income
must be below 200 percent of the Federal poverty level
($17,960 for a single person and $24,240 for a married
couple in 2003).
Nebraska
There are no State Assistance Programs that offer prescription drug coverage in Nebraska.
Nevada
Senior Rx
Phone number: 1-800-243-3638
State website: www.nevadaseniorrx.com
What is covered: Frequently prescribed drugs.
Who is eligible: Residents age 62 or older who have lived
continuously in the state for at least one year. Annual
income must be $22,016 or less for a single person, or
combined income of $28,660 or less for married couples.
(Income levels are adjusted each year.) Medicaid enrollees
are not eligible.
16
• How it works: You pay $10 for each generic prescription,
and $25 for brand-name drugs. For drugs that are not
covered or authorized as medically necessary, you have the
opportunity to buy the drug at the pharmacy discount rate.
Senior Rx provides up to $5,000 in benefits per year.
New Hampshire
Senior Prescription Drug Discount Program
• Phone number: 1-800-580-8902
• State website: Not available
• Who is eligible: Residents age 65 or older who have no
other prescription coverage.
• How it works: You present a discount card to participating
pharmacies and receive discounts ranging from 13 to 45
percent on prescription costs. There is no enrollment fee.
New Jersey
Pharmaceutical Assistance to the Aged and Disabled (PAAD)
and Senior Gold
•
•
•
•
Phone number: 1-800-792-9745
State website: www.state.nj.us/health/seniorbenefits
What is covered: Prescriptions drugs and diabetic supplies.
Who is eligible: Residents age 65 or older, or over 18 and
disabled, who meet income guidelines. For PAAD, annual
income must be less than $20,016 if single or $24,542 if
married. For Senior Gold, income must be $20,016$30,016 if single or $24,542-$34,542 if married. Income
limits increase each year based on the Social Security costof-living increase. People with Medicaid are not eligible. If
you have health insurance that provides limited or partial
drug coverage, you are eligible.
• How it works: PAAD enrollees pay $5 for each prescription. Senior Gold enrollees pay $15 plus 50 percent of the
remaining cost of the drug. After your out-of-pocket costs
exceed $2,000 for a single person or $3,000 for married
couples, you pay only $15 per prescription. All enrollees
17
must use generics when available or they pay the difference
in price along with the copayment. Program does not cover
drugs purchased outside of New Jersey or any drugs whose
manufacturer has not signed a rebate agreement with the
state.
New Mexico
SeniorRx Program
• Phone number: Benefits: 1-877-206-7434; Enrollment:
1-866-244-0882 (884-6543 in Albuquerque)
• State website: www.nmrhca.state.nm.us/spdp
• What is covered: All prescription drugs.
• Who is eligible: Residents who are age 65 or older.
• How it works: You present a discount card to participating
pharmacies and save an average of 13 percent on brandname drugs and 50 percent on generic drugs. Through a
mail-order service you save an average of 19 percent on
brand-names and 55 percent on generics. Call the state
Agency on Aging at 1-800-432-2080 for information on
other discount prescription drug programs offered by drug
companies, the VA, etc.
New York
Elderly Pharmaceutical Insurance Coverage (EPIC)
• Phone number: 1-800-332-3742
• State website: www.health.state.ny.us/nysdoh/epic/faq.htm
• What is covered: Almost all prescription drugs and insulin
supplies. Both brand-name and generic drugs are included.
Enrollees can buy up to 100 tablets or a 30-day supply at a
time.
• Who is eligible: Residents who are age 65 or older and have
an annual income of $35,000 or less if single, or $50,000 or
less if married. Those with Medicaid or other prescription
drug coverage that is better than EPIC are not eligible.
However, if you exceed your drug limit with another
insurer, you may join EPIC for the rest of the year.
18
• How it works: Seniors with incomes up to $20,000 for
singles and $26,000 for married couples pay an annual fee
that ranges from $8 to $300, depending on income. Those
with higher incomes pay no fee but are responsible for a
deductible that ranges from $530 to $1,715, depending on
income. Once fee is paid or deductible is met, enrollees pay
$3 to $20 for each prescription, depending on the full price
of the drug.
North Carolina
Senior Care Program
• Phone number: 1-866-226-1388
• State website: www.ncseniorcare.com
• What is covered: Prescription drugs and insulin used to
treat high blood pressure, high cholesterol, chest pain,
irregular heartbeat, sugar diabetes, heart failure, emphysema, bronchitis, asthma.
• Who is eligible: Residents age 65 or older. Annual income
must be less than 200 percent of the Federal poverty level.
In 2003, $17,720 or less if single, and $23,880 or less if
married. You are not eligible if you are receiving drug
benefits through Medicaid, VA, TriCare, or a Medicare
supplemental policy. Applicants must certify that they have
one of the covered illnesses. Annual re-enrollment is
required.
• How it works: Program covers 60 percent of the first
$1,000 of costs for drugs used for covered illnesses. You
pay the remaining 40 percent, plus a $6 fee for each 30-day
prescription. Any costs above the $600 covered by the
program and the cost of drugs for illnesses not covered by
it are your responsibility.
North Dakota
• There are no State Assistance Programs that offer prescription drug coverage in the state of North Dakota.
19
Ohio
Golden Buckeye Card Program
• Phone Number: Not available
• State website: www.goldenbuckeye.com
• Who is eligible: Residents age 60 and older, or any age if
disabled.
• What is covered and how it works: This program is not yet
operational but is expected to begin in September 2003
(there could be further delays while the state tries to sign up
more pharmacies). A Golden Buckeye senior discount card
has long been available for general purchases; a prescription benefit is now being added. Details on coverage and
fees are not yet available. Once the plan begins, new cards
will be mailed to all residents age 60 and over. You may
also apply for one at public libraries and senior centers.
Oklahoma
• There are no State Assistance Programs that offer prescription drug coverage in the state of Oklahoma.
Oregon
Senior Prescription Drug Assistance Program
• Phone number: 1-800-359-9517
• State website: www.dhs.state.or.us/seniors/aging
• What is covered: Most prescription drugs but not over-thecounter drugs.
• Who is eligible: Residents age 65 or older who have income
below 185 percent of the Federal poverty guideline ($1,384
per month in 2003) and less than $2,000 in liquid resources.
Income and resources are based on individual's levels, not
household's, even if you are married. You must not have
been covered by any public or private drug benefit program
in the past six months (this does not count discount programs).
• How it works: You buy drugs at the state's reduced Medic20
aid rate at participating pharmacies. There is an annual $50
fee. You must renew annually.
Pennsylvania
1. Pharmaceutical Assistance Contract for the Elderly
(PACE)
•
•
•
•
Phone number: 1-800-225-7223
State website: www.aging.state.pa.us
What is covered: Prescription drugs.
Who is eligible: Must be age 65 or older and a resident of
the state for at least 90 days. Those covered by Medicaid
prescription drug program are not eligible. Income for
previous year must be $14,000 or less for a single person
and $17,200 or less for a married couple.
• How it works: You pay $6 for each prescription.
2. PACE Needs Enhancement Tier (PACENET)
• Who is eligible: Age, residency, and Medicaid requirements
are the same as for PACE. However, the income limits are
higher. Income must be between $14,000 and $17,000 for
a single person, and between $17,200 and $20,200 for a
married couple.
• How it works: There is a $500 deductible. After that is met,
you pay $8 for generic prescription drugs and $15 for
brand-name drugs.
Rhode Island
Pharmaceutical Assistance for the Elderly (RIPAE)
• Phone number: 1-401-462-4000 or 1-800-322-2880
• State website: Not available
• What is covered: Medications for most chronic conditions
and other selected conditions.
• Who is eligible: Residents age 65 or older who meet income
guidelines. Must not be eligible for Medicaid, and if you
21
have another prescription drug benefit you must exhaust it
before applying for the program.
• How it works: Enrollees present a discount card to participating pharmacies. The state pays 60 percent of the cost of
covered drugs if your annual income is under $16,919
(single person) or $21,149 (married couple). The state pays
30 percent if your income is $I6,92O-$2I,238 (single) or
$2l,l5O-$26,548 (married couple). The state pays 15
percent if your income is $2l,239-$37,l37 (single) or
$26,549-$42,476 (married couple). Income amounts increase slightly each year.
South Carolina
SILVERx Card
• Phone number: 1-877-239-5277
• State website: www.silverxcard.com
• What is covered: All prescriptions covered by Medicaid,
including prescribed over-the-counter drugs.
• Who is eligible: People age 65 or older who have been
residents for six months and have no prescription drug
coverage. Income must be below 200 percent of the poverty level ($17,960 per year for a single person and $24,240
for married couples in 2003). Open enrollment throughout
year.
• How it works: You pay the first $500 per year of drug costs.
After you meet this deductible, you pay only $10 for
generic drugs, $15 for brand-name drugs, and $21 for drugs
requiring special authorization. Generic drugs are mandatory when available. You must buy from a participating
pharmacy. There is a maximum of four prescriptions or
refills each month, although more may be covered for
certain drugs or illnesses.
South Dakota
Rx Access
• Phone number: 1-866-854-5465
22
State website: www.state.sd.us/social/ASA/Medications/
RxAccess.htm
What is covered: Medications covered by the assistance
programs offered by drug companies.
Who is eligible: Residents who are age 19 or older, have no
prescription drug coverage through private insurance, do
not qualify for any state programs that cover drug costs,
and meet income and asset guidelines. For a single person,
income must be below $10,000 per year and financial
assets (checking and savings accounts, stocks, bonds, CDs,
annuities, etc.) below $4,000. A couple must have income
under $14,000 and assets worth less than $6,000.
How it works: The program helps people gain access to
drug company assistance programs which supply prescription medications at no or low cost. In addition, a pharmacist
will review all medications a person is taking and may
consult with a person's doctor if necessary. The program
does not pay for medications or reimburse past expenses.
The assistance provided by the drug manufacturers is
generally intended to be temporary. A new prescription
drug discount card plan was approved in March 2003
but is not yet operational. It probably will cover most
people on Medicare. Details are not yet available.
Tennessee
Tennessee passed a law in 2003 to create a prescription drug
coverage program but it is not yet operational. The
TennCare Rx Program will help people with no prescription
drug coverage. Details are not available.
Texas
Texas passed a law in 2001 to create a prescription drug
coverage program but it is not yet operational. Its launch
has been postponed indefinitely due to lack of funds.
23
Utah
• There are no State Assistance Programs that offer prescription drug coverage in the state of Utah.
Vermont
Healthy Vermonters
•
•
•
•
Phone number: 1-800-250-8427
State website: www.healthyvermonters.org
What is covered: Drugs covered by Medicaid.
Who is eligible: All residents who have no insurance for
prescriptions or have a commercial insurance plan with a
yearly limit, and have incomes below a threshold. People
who are age 65 or older, or disabled, must have incomes
below 400 percent of the Federal poverty limit. In 2003,
this translates to a monthly income of $2,994 for a household of one person and $4,004 for two people. Other
Vermonters must have incomes below 300 percent of the
poverty limit. In 2003, this translates to $2,245 per month
for one person, $3,030 for two, and $3,815 for a household
of three.
• How it works: You pay the state's discounted rate for drugs.
Additional discounts may soon be available, and when
these are added there will be an enrollment fee. Older or
disabled Vermonters with lower incomes may also qualify
for the VScript and VScript Expanded programs, which
cover fewer drugs but may cost less out-of-pocket. Beneficiaries in these other plans are automatically enrolled in the
Healthy Vermonters program to cover drugs that they
exclude.
Virginia
• There are no State Assistance Programs that offer prescription drug coverage in the state of Virginia.
24
Washington
• Washington passed a law in June 2003 to create a prescription drug coverage program but it is not yet operational. It
will cover residents age 50 and older, or age 18-49 and
disabled, who have incomes below 300 percent of the
Federal poverty level. After paying an enrollment fee,
participants will be able to buy drugs at discounted prices.
West Virginia
Golden Mountaineer Discount
• Phone number: 1-877-987-3646
• State website: www.state.wv.us/seniorservices
• What is covered: Pharmaceutical discounts, retail and
professional discounts.
• Who is eligible: All residents age 60 and older.
• How it works: A discount card provides discounts through a
network of participating pharmacies on many drugs commonly used by seniors. Discounts vary by pharmacy and
drug type.
Wisconsin
Wisconsin SeniorCare
•
•
•
•
Phone number: 1-800-657-2038
State website: www.dhfs.state.wi.us/seniorcare
What is covered: Most prescription drugs.
Who is eligible: Residents age 65 or older. There are no
income or asset tests, but benefits vary with income. There
is a $30 enrollment fee per person. People with prescription
drug coverage through other plans, except Medicaid, are
eligible.
• How it works: Level One: If your income is below $14,368
annually ($19,392 for couples), there is no deductible and
you pay $5 for generics and $15 for brand-name drugs.
Level Two: If your income is $14,369 to $21,552 ($19,393
25
to $29,088 for couples) there is a $500 deductible per
person. You pay a discounted price for drugs until the
deductible is met. After that, you pay $5 for generics and
$15 for brand-name drugs. Level Three: If your income is
$21,553 or higher ($29,089 or higher for couples) you pay
the retail price for drugs until your total outlays equal the
difference between your income and $21,553 ($29,089 for
couples). During this "spend down" period your drug costs
are tracked automatically, after which you qualify for Level
Two. The income amounts are based on the Federal poverty
guidelines, which increase every year.
Wyoming
Prescription Drug Assistance Program
•
•
•
•
Phone number: 1-800-442-2766 or 307-777-7531
State website: Not available
What is covered: All prescription drugs.
Who is eligible: Enrollment closed in June due to budget
constraints. Prior to that, residents with income below the
Federal poverty level ($8,860 for individuals, $11,940 for
married couples) were eligible. No age restrictions. Must
not be eligible for any other prescription drug insurance,
including Medicaid.
• How it works: You may buy up to three drugs per month for
a small copayment per prescription ($10 for generics and
$25 for brand-name drugs) at participating pharmacies.
26
DRUG COMPANY DISCOUNT CARDS
S
OME drug companies have special programs to make prescriptions
more affordable. They offer "drug assistance programs" for people
of all ages with very low incomes. Sometimes the drugs are provided free of charge. Each program has its own requirements, and you
must have no public or private insurance that covers prescription drugs.
Usually a doctor must contact the company to make the initial arrangements. Ask your doctor if any such plans would help you with your medication.
Drug companies also offer discount cards. To be eligible, usually you
must be on Medicare, have no prescription drug insurance, and meet income
requirements. Usually the cards cover only brand-name prescription drugs
and not generics. If there is a generic equivalent for your drug and it is not
covered by a discount card, check to see if it would be cheaper to buy the
generic out-of-pocket rather than use the card to buy the brand-name drug.
The major discount programs are described below.
GlaxoSmithKline
The Orange Card program helps you save on drugs manufactured by
GlaxoSmithKline. To be eligible, you must be 65 or older, or over 18
and disabled, and enrolled in Medicare. Your annual income must be
below $30,000 for a single person and $40,000 for a couple, and you
must have no public or private insurance that pays for prescription drugs
(state-issued discount cards are not counted as insurance).
When you use the Orange Card, you receive a discount averaging 30
percent per prescription. The discount is not available on any drugs that
are covered by Medicare or Medicaid. You cannot use it in combination
with any other discount card. In other words, it applies only to drugs for
which you are paying the full retail price yourself.
To enroll, call to ask for an application form. You can find out more
about the program, see which drugs are covered, and download an
application at the company's website. GlaxoSmithKline also participates in another drug discount program, the Together Rx Card. See
below for more details.
Phone number: 1-888-ORANGE-6 (1-888-672-6436)
Website: http://us.gsk.com/card
27
Eli Lilly
Eli Lilly and Company offers the LillyAnswers discount card. To be
eligible, you must be a senior or a disabled person and be enrolled in
Medicare. Your annual income must be below $18,000 for a single
person, or $24,000 for a household, and you must have no prescription
drug coverage.
With the card, you can buy a 30-day supply of a Lilly drug for $12 per
prescription. Coverage lasts for 12 months, after which you have to requalify by applying again. Call for an application or download one from
their website.
Phone number: 1-877-RX-LILLY (1-877-795-4559)
Website: www.lillyanswers.com
Novartis
The Novartis Savings Program is available to patients enrolled in Medicare who have no prescription drug coverage and meet income requirements. There are two components to the program.
If your annual income is below $28,000 for a single person, or $38,000
for a couple, you qualify for the Together Rx Card, a discount card
offered by an alliance of major drug companies. (In Alaska, the income
limits are $35,000 for a single person and $48,000 for a couple. In
Hawaii, they are $33,000 and $44,000, respectively.) When you use the
card at a participating pharmacy you receive a discount of 25 to 40
percent off the retail price of selected drugs made by Novartis or any of
the other companies.
Alternatively, if your annual income is below $18,000 for a single person or $24,000 for a couple, you simply pay $12 for each Novartis
prescription.
All enrollees now use the Together Rx Card. Previously, they received
a Novartis Care Card. This card is still valid but it does not cover drugs
made by other companies. If you have the older card, you should apply
for the Together Rx Card to receive discounts from more participating
drug companies. See below for more information on the Together Rx
program.
Phone number: 1-800-865-7211.
Website: www.careplan.novartis.com
28
Pfizer
Pfizer offers the Pfizer Share Card to anyone who is enrolled in Medicare, has no prescription drug coverage, and has an annual income
below $18,000 for a single person or $24,000 for a couples.
With the card, you pay $15 for up to a 30-day supply of each drug
covered by the program. Call for an enrollment kit, and see the website
for more details.
Phone number: 1-800-459-4156.
Website: www.pfizersharecard.com
Together Rx
In 2002, an alliance of seven major pharmaceutical companies introduced the Together Rx Card, which enables you to use just one card to
receive discounts on prescription drugs made by any of the participating
companies. Participants now include Abbott Laboratories, AstraZeneca,
Aventis Pharmaceuticals, Bristol-Myers Squibb, GlaxoSmithKline,
Janssen Pharmaceutica (owned by Johnson & Johnson), Novartis, and
Ortho-McNeil.
According to the program, the Together Rx Card provides discounts of
20 to 40 percent on more than 170 medicines. Most of them are brandname drugs, but some pharmacies also offer savings of at least 15 percent on generic s.
To qualify for the card, you must be enrolled in Medicare, have no
public or private prescription drug coverage, and have an annual income
below $28,000 for a single person or $38,000 for a couple. (The income
limit in Alaska is $35,000 for a single person and $48,000 for couples;
in Hawaii, $33,000 for a single person and $44,000 for couples). If your
income is very low, you will be notified if you qualify for any of the
patient assistance programs offered by the participating companies.
Call for enrollment form, or download a form and see a list of covered
drugs at the program's website.
Phone number: 1-800-865-7211
Web site: www.together-rx.com
29
VETERANS' HEALTH BENEFITS
I
N 1996, Congress passed the Veterans' Health Benefits Eligibility Reform Act, which made many more veterans eligible for health benefits,
including prescription drug coverage. So many veterans signed up that
the veterans' health care system has been overwhelmed. Its costs for providing drugs and other benefits have soared, and the funding authorized by
Congress has not kept pace.
In response, the Department of Veterans Affairs (VA) has been looking
for ways to rein in the growth of spending while continuing to provide
adequate services. It is discouraging new enrollment and making some
veterans ineligible for benefits. It also is increasing the portion of costs that
veterans must pay out-of-pocket.
Enrolled veterans generally pay $7 for each 30-day prescription (until
recently, it was only $2). For some veterans, such as those with low incomes or those with a service-related disability, this copayment is waived.
To receive prescription drugs, all veterans must first enroll in the VA
health care system. To enroll, you fill out an application and based on your
specific eligibility status, you are assigned to a "priority group." Veterans
with higher priority (those with service-connected disabilities, former
POWs, recipients of the Purple Heart, etc.) are enrolled faster. Once enrolled, all veterans are eligible for the same benefits, but higher priority is
sometimes given to selected veterans.
As of January 17, 2003, eligibility rules were tightened and the VA is
not accepting new "Priority Group 8" veterans for enrollment. This lowpriority group covers higher-income veterans who have no compensable
service-connected disability and who applied for enrollment after January
16, 2003. In 2003, it includes veterans with annual incomes of $24,644 or
higher if single, or $29,576 or higher if they have one dependent. The
income thresholds are tied to the Federal government's requirements for
public housing benefits and will increase slightly each year.
The VA usually fills only prescriptions written by VA doctors. This
means you must see a VA primary-care doctor for an initial examination
before getting any prescriptions filled. If you have prescriptions written by
an outside doctor, bring them to the VA doctof. You can use the VA as
your primary or secondary health care provider (e.g.* you can continue to
see your non-VA doctor as well, if you have one), but generally the VA
will pay only for goods and services that it provides or authorizes.
Because there is often a long waiting list to see VA doctors for an initial
30
visit, the VA recently made an exception to its rule requiring an initial
exam before getting a prescription filled. Now, the VA will fill prescriptions written by non-VA physicians for veterans who have been waiting to
see a physician.
This new "Transitional Pharmacy Benefit" was announced in July 2003
and will start on September 22, 2003. To be eligible for it, veterans must
have enrolled in the VA health care system before July 25, 2003; must
have requested their first primary-care appointment with a VA doctor
before then; and must have waited more than 30 days for that appointment
as of September 22,2003. All prescriptions will be filled by the VA through
the mail.
For further information on any and all VA benefits, contact your local
veterans' benefits office or use the contacts listed below. Ask for a copy of
the booklet Federal Benefits for Veterans and Dependents (2003 edition).
There is also a wealth of information at the VA website. To apply for VA
health care you need to fill out Form 10-10EZ, which you can get at any
veterans' benefits office or VA health care facility, request over the phone,
or download from the VA website.
Phone numbers:
1-800-827-1000 for VA benefits
1-877-222-VETS (1-877-222-8387), for VA health benefits
Websites:
www.va.gov
www.va.gov/elig/index.htm (for health benefits)
31
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