MGH Community News

CATASTROPHIC DRUG COVERAGE- THE "PHARMACY PROGRAM PLUS"

In addition to the expansion of the Senior Pharmacy Program as reported recently (MGH Community News, December 1999), Massachusetts has established a new, temporary, catastrophic pharmacy program. This program will expire December 31, 2000. The plan is to have another permanent program in place by that time. The Senior Pharmacy Program is changing its name to "the Pharmacy Program". This catastrophic drug program is called "the Pharmacy Program Plus".

Eligibility requirements (applicants must meet ALL of the following):

Over 65 or under 65 and disabled.
Income of up to 500% of Federal Poverty Level
Paid pharmacy expenses that exceeded 10% of family income in at least three of the 6 months prior to application
Continued need for prescription drugs expected to exceed 5% of gross family income.
Exhausted all prescription-drug coverage, but may have a Medicare HMO that provides a limited prescription-drug benefit that exhausts quarterly.

Benefits:

There is a $3 copay for generics, insulin and disposable insulin syringes with needles and a $10 copay for brand-name drugs All remaining costs are covered by the program. There is no monetary limit to the benefit. However, there is the possibility that an enrollment cap will be necessary to limit the number of members in the program. So those eligible should apply early. If an enrollment cap is placed, first priority will be given to those with greatest financial need, second to those who had unlimited drug coverage on December 31, 1998 through a Medicare HMO agreement that has been discontinued. All others would be third priority.

Application is made through the Pharmacy Program. Call 1-800-AGE-INFO (1-800-243-4636) for an application. Or contact The Community Resource Center.

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