MEDICARE DRUG DISCOUNT CARDS

On November 11th the Community Resource Center’s educational program focused on Medicare Drug Discount Cards. The Medicare Prescription Drug Improvement and Modernization Act (MMA) was passed about a year ago. The Prescription Drug Discount Cards, which began offering benefits on June 1, 2004, are stop-gap measure until January 2006 when the full prescription drug benefit or “Medicare Part D” coverage begins.

Key Points

The cards are confusing and require an investment of time to find the best one, plus a yearly fee. It can be an overwhelming and anxiety-provoking topic for Medicare beneficiaries. To simplify, for now we can advise patients:

Definitely apply IF qualify for low-income credit *

AND apply before the end of 2004 (or as soon as eligible)

Everyone else – savings are modest, not a huge loss if you don’t apply

Medicare part D will offer more coverage – apply in late 2005. This deadline is the important one. Part D coverage is optional, but if you opt-in late there will be significant penalties.

Medicare Drug Card Basics

Enrollment is voluntary

Program offered by private insurance companies – not Medicare

Discounts are modest – average 10 - 15%, a few discounts as high as 25%

Enrollment fee $30/year max. Medicare covers fee for “Low Income” members

Medicare Approved Logo

Medicare approved cards will display logo

Th ere are many other drug discount cards unrelated to this program

Eligibility

To be eligible for a Medicare Drug Discount Card one:

Must have Medicare,

AND

NOT be eligible for Medicaid/MassHealth

Low-Income Credit AKA “Transitional Assistance”

Eligibility:

* Income in 2004 is $12,569 per year or less individual, or $16, 862 or less for a married couple

AND

NOT receiving prescription assistance from the federal government or an employer (some exceptions)

Benefits:

Medicare pays enrollment fees

$600 credit each year (2004 & 2005); patient pays 5 –10% co-pay until credit used

Any leftover credit from 2004 carries-over to 2005, even if switch cards

BUT if don’t apply until 2005 get max $600

If apply after March 1, 2005 lose $150 of credit for every three month period

Discount Card Benefits & Cautions

Decide whether or not to get a card – is it worth it given enrollment fee and expected savings? Explore all options

Compare cards based on:

Medications needed and associated discounts

Pharmacy network

State coverage (especially “snow birds”)

Card sponsors can change medications covered and discounts at any time

Can only have one Medicare-approved card per calendar year

Can still enroll for 2004

Open enrollment for 2005 is November 15 – December 31, 2004

Special enrollment periods when lose coverage

Medicare HMO Members

If belong to Blue Care 65- can only enroll in the card program offered by Blue Cross/Blue Shield of Massachusetts

If belong to another Medicare HMO, can enroll in any card offered

Medicare Contact Info

To apply, compare cards, or file a complaint:

www.medicare.gov , or 1-800-MEDICARE (800-633-4227), or TTY 877-486-2408

Compare Against Alternatives

PRESCRIPTION ADVANTAGE

Though enrollment is technically closed, they are currently enrolling those who are:

age 65 (to 66th birthday)

OR 66+ and have lost coverage

OR disabled

If eligible for the low-income credit, use it before Prescription Advantage

If have Prescription Advantage – use their sponsored card

DRUG COMPANY OFFERINGS

Discount cards- several are still available, though may be phased out

“Pfizer Pfriends” - available to all based on income, Medicare “Low Income” members can pay flat $15 per prescription after exhaust $600 credit (but only Pfizer drugs)

“Indigent”drug programs

CITIZEN’S HEALTH

$12/year individual, $28/yr. Family

“Typical savings off retail prices of 12 – 25%off brand-name drugs and 35 - 50% for generic”

www.Citizenshealth.com or 800-JOE- K-4RX

MAYOR’S NEIGHBORHOOD PHARMACY PROGRAM

Boston Residents

12% off at local pharmacies

No yearly fee

OTHER

Discuss generic drugs with MD - an appropriate option?

Non-Medicare cards

Discount clubs – e.g., Costco

Internet pharmacies

Canadian pharmacies

INDIVIDUAL ASSISTANCE

These Massachusetts resources can help individuals choose the best option for them:

SHINE (Serving the Health Information Needs of the Elderly) 800-243-4636

Mass Medline 866-633-1617

Patient Handouts

As you may recall, the Community Resource Center has designed two-versions of a patient handout on the Medicare Discount Drug Cards. These are available to social service staff on our web-site: www.mghsocialwork.org > Staff Access > Community Resource Center > Basic Needs > Health Care Coverage > >Medications/Prescription Drugs

Medicare Part D (Prescription Coverage) Brief Preview

Starts January 2006

Tiers of coverage based on income with varying premiums, deductibles, co-pays

“Catastrophic” coverage for those over 150% FPL when reach $2850 out-of-pocket; then covers at 95%

Dual Eligibles (MassHealth/Medicare) will be moved to Part D, which is less generous

Penalty for late enrollment - 1% PER MONTH

No new Medigap plan drug-coverage

Current plan holders “grandfathered in”

May compromise viability of existing plans

May face penalty if sign-up for Part D later

More information and training will be offered closer to the open enrollment period for Medicare Part D, expected to be in November 2005.

-Thanks to Donna McCormick, Greater Boston Legal Services, Medicare Advocacy Project for the use of her slides.