MGH Community News

PHARMACEUTICAL COMPANIES' MEDICARE ASSISTANCE PROGRAMS

The major pharmaceutical companies have, for some time now, had programs under which "indigent" patients could obtain temporary supplies of prescription medications through their health center or physician's office. See the September 2001 MGH Community News article, "Pharmaceutical Companies' Patient Assistance Programs". Three pharmaceutical companies have introduced additional programs in the past few months aimed at the Medicare population. A Boston Globe article from 1/16 reports, "(Hank) McKinnell (Pfizer, Inc. chairman and chief executive) said the company acted after congresssional efforts to pass a prescription drug benefit for seniors were delayed because of the September terrorist attacks." The same article notes that "some analysts praised Pfizer's action but questioned whether the company was trying to stem criticism about escalating drug costs. 'This is an effort to take some of the pressure off,' predicted John Rother, policy director for AARP. 'It means the industry is feeling the heat with public discontent over prices and certainly feeling the heat from the Congress as well.'" Jeffrey Shapiro, Senior Institutional Healthcare Representative acknowledged that Pfizer won't be making money on the individual users of their discount card, but that they expect to benefit by getting physicians in the habit of prescribing Pfizer brand-name drugs. Whatever the companies' reasons for offering them, these programs can be useful, so a summary follows.

PFIZER SHARE CARD
Benefits: Customer pays $15 flat fee for up to one month supply of each Pfizer prescription drug. No cap on benefits. This differs from discount cards in that it does not increase as drug price increases. Can be used at any pharmacy. Most Pfizer drugs are covered including Lipitor, Norvasc, Zoloft, Procardia, Zithromax, Diflucan. One exception is Celebrex which is co-promoted with Pharmacia and is currently not included in the program.
They also offer an information hotline featuring trained operators and free health education materials and resources.
Eligibility:

Enrolled in Medicare (senior or disabled for 2 years),

no prescription drug coverage,

annual gross income of less than $18,000 for an individual or $24,000 for a couple.

Information/Application:
Program begins March 1, 2002. Call 800-717-6005 to enroll. For more information you can also visit the website - www.pfizerforliving.com and click on the Share Card section at the bottom of the page.

NOVARTIS CARE CARD
Benefits: Discount card- estimate savings of 25% or more on selected Novartis prescription drugs. Includes Clozaril, Lopressor, and Tegretol. See website for complete drug listing.
Eligibility:

Medicare recipient
Income less than 300% of FPL- approximately $26,000 for an individual or $35,000 for a couple

Information/Application:
Program began January 2, 2002. Call 866-974-CARE (2273) or visit www.novartis.com/carecard/

GLAXOSMITHKLINE ORANGE CARD
Benefits: Discount card, estimate 30% savings or more in some cases on all GlaxoSmithKline outpatient drugs. Includes Paxil, Wellbutrin, and Zofran. See website for additional drugs.
Eligibility:

Enrolled in Medicare
Income at or below 300% of FPL- approximately $26,000 for an individual or $35,000 for a couple
Lack public or private insurance or other pharmaceutical benefit such as Medicaid.

Information/Application: Began January 1, 2002. 800-888-ORANGE6 or visit www.gsk.com/press_archive/press_10032001.htm

SEE ACCOMPANYING GRID TO COMPARE PLANS.

Massachusetts Prescription Plans Grid
January 2002

Prescription Advantage Citizen's Health Mayor's Neighborhood Pharmacy Plan

Administration Executive Office of Elder Affairs Citizen's Energy
(Joe Kennedy) City of Boston

Contact 800-AGE-INFO
800-243-4636
www.800ageinfo.com 800-JOE-K-4RX
800-563-5479
www.citizensenergy.com 617-635-3993

Description Insurance plan Discount card Discount plan

Eligibility:

Income No limit for elders;
disabled income less than or equal to 188% FPL- $16,152 indiv, $21,820 couple No limit 400% or less of FPL- $34,360 indiv, $46,440 couple

Age/Disability 65 or older or disabled Not required 65+ or disabled Medicare recipients

Citizenship Not required Not required Not required

Other criteria Must be MA resident for past 6 months; no prescription drug coverage or coverage exhausted. Paying full price of at least some prescription drugs. Boston Resident, not enrolled in health plan that pays for prescriptions or have reached prescription cap.

Benefits Covers all prescription medications, but in a 3 tiered system. Covers all prescription meds at participating pharmacies. Savings will vary. Average savings of 25% off retail on brand name drugs, 35-50% on generics. 12% discount on drugs at participating pharmacies

Fees/costs Premiums, deductibles and co-pays dependent on income and tier of drug. State pays premiums and deductibles for those with income less than or equal to 188% FPL. Maximum out of pocket for deductibles and co-pays is lesser of $2,000 or 10% of income. Steeper discounts available thru mail-order. $12/year individual
$28/year family (couples apply as two individuals). Cost of medications. Steeper discounts available thru mail-order. $3 co-pay.

Pharmacies Can be used nationwide. Not CVS, Walgreens. National network expected in Feb. 2002. Participating Boston Pharmacies

Limitations Low income <65 and not disabled are not eligible. Citizen's Health offers better discounts.

Pfizer Share Card GlaxoSmithKline Orange Card Novartis Care Card

Administration Pfizer Pharmaceuticals GlaxoSmithKline Pharmaceuticals Novartis Pharmaceuticals

Contact 800-717-6005
www.pfizerforliving.com 888-ORANGE6
888-672-6436 866-974-CARE
866-974-2273
www.novartis.com/carecard

Description Hybrid plan Discount card Discount card

Eligibility:

Income Below $18,000/ individual, $24,000/couple At or below 300% FPL- approx. $26,000 indiv, $35,000 couple At or below 300% FPL- approx. $26,000 indiv, $35,000 couple

Age/Disability Enrolled in Medicare Enrolled in Medicare Enrolled in Medicare

Citizenship Required Required Required

Other criteria No other prescription drug coverage Lack public or private insurance programs or other pharmaceutical benefit program. No alternative prescription drug coverage such as Medicaid, Medigap or employer-sponsored retiree coverage.

Benefits $15 flat fee per prescription. Covers most Pfizer meds. No caps or other limits on the number of refills or prescriptions. Average savings of 30% off GlaxoSmithKline outpatient medicines. Average savings of 25% off Novartis outpatient medicines.

Fees/costs No membership fee- just the $15 per prescription No fee. But must pay average of 70% of cost of drug. No fee. But must pay average of 75% of cost of drug.

Pharmacies All pharmacies All pharmacies All pharmacies

Limitations Only their drugs. Only their drugs. Generics may be cheaper. May want to compare price with Citizen's Health. Only their drugs. Generics may be cheaper. May want to compare price with Citizen's Health.

1/02

	Prescription Advantage	Citizen's Health	Mayor's Neighborhood Pharmacy Plan
Administration	Executive Office of Elder Affairs	Citizen's Energy (Joe Kennedy)	City of Boston
Contact	800-AGE-INFO 800-243-4636 www.800ageinfo.com	800-JOE-K-4RX 800-563-5479 www.citizensenergy.com	617-635-3993
Description	Insurance plan	Discount card	Discount plan
Eligibility:
Income	No limit for elders; disabled income less than or equal to 188% FPL- $16,152 indiv, $21,820 couple	No limit	400% or less of FPL- $34,360 indiv, $46,440 couple
Age/Disability	65 or older or disabled	Not required	65+ or disabled Medicare recipients
Citizenship	Not required	Not required	Not required
Other criteria	Must be MA resident for past 6 months; no prescription drug coverage or coverage exhausted.	Paying full price of at least some prescription drugs.	Boston Resident, not enrolled in health plan that pays for prescriptions or have reached prescription cap.
Benefits	Covers all prescription medications, but in a 3 tiered system.	Covers all prescription meds at participating pharmacies. Savings will vary. Average savings of 25% off retail on brand name drugs, 35-50% on generics.	12% discount on drugs at participating pharmacies
Fees/costs	Premiums, deductibles and co-pays dependent on income and tier of drug. State pays premiums and deductibles for those with income less than or equal to 188% FPL. Maximum out of pocket for deductibles and co-pays is lesser of $2,000 or 10% of income. Steeper discounts available thru mail-order.	$12/year individual $28/year family (couples apply as two individuals). Cost of medications. Steeper discounts available thru mail-order.	$3 co-pay.
Pharmacies	Can be used nationwide.	Not CVS, Walgreens. National network expected in Feb. 2002.	Participating Boston Pharmacies
Limitations	Low income <65 and not disabled are not eligible.		Citizen's Health offers better discounts.

	Pfizer Share Card	GlaxoSmithKline Orange Card	Novartis Care Card
Administration	Pfizer Pharmaceuticals	GlaxoSmithKline Pharmaceuticals	Novartis Pharmaceuticals
Contact	800-717-6005 www.pfizerforliving.com	888-ORANGE6 888-672-6436	866-974-CARE 866-974-2273 www.novartis.com/carecard
Description	Hybrid plan	Discount card	Discount card
Eligibility:
Income	Below $18,000/ individual, $24,000/couple	At or below 300% FPL- approx. $26,000 indiv, $35,000 couple	At or below 300% FPL- approx. $26,000 indiv, $35,000 couple
Age/Disability	Enrolled in Medicare	Enrolled in Medicare	Enrolled in Medicare
Citizenship	Required	Required	Required
Other criteria	No other prescription drug coverage	Lack public or private insurance programs or other pharmaceutical benefit program.	No alternative prescription drug coverage such as Medicaid, Medigap or employer-sponsored retiree coverage.
Benefits	$15 flat fee per prescription. Covers most Pfizer meds. No caps or other limits on the number of refills or prescriptions.	Average savings of 30% off GlaxoSmithKline outpatient medicines.	Average savings of 25% off Novartis outpatient medicines.
Fees/costs	No membership fee- just the $15 per prescription	No fee. But must pay average of 70% of cost of drug.	No fee. But must pay average of 75% of cost of drug.
Pharmacies	All pharmacies	All pharmacies	All pharmacies
Limitations	Only their drugs.	Only their drugs. Generics may be cheaper. May want to compare price with Citizen's Health.	Only their drugs. Generics may be cheaper. May want to compare price with Citizen's Health.