Prescription Advantage is designed on an insurance model with premiums, co-pays, deductibles and out-of-pocket limits varying based both on household income and the number and level of expenses of those enrolled. The Pharmacy Program Plus closes on 3/31/01, and The Pharmacy Program closes on 9/30/01.
Eligibility:
Must be a resident of Massachusetts and not a MassHealth or CommonHealth member. Must also be either:
- 65 or older OR
- Under 65, disabled and have a gross annual household income less than $16,152 (individual) or $21,828 (married couple) (or 188% of poverty for other household configurations) and either do not work or work 40 hours or less per month OR
- enrolled in the Pharmacy Program or Pharmacy Program Plus as of March 31, 2001.
Note that there is no income limit for those 65 and older, and that previously the under 65 population only needed to report the income of the individual. Now household income is considered.
Benefits:
- The cost of most prescription drugs is covered, including insulin and disposable insulin syringes with needles.
- No dollar limit to the benefit provided, however these benefits can only be accessed after other prescription drug coverage has been exhausted.
- Co-pays vary depending on whether they are generic drugs, "Select Brand-Name Drugs" or "Additional Brand-Name Drugs" and whether one uses a retail pharmacy their mail order pharmacy. Please see the accompanying rate schedule.
- Deductibles and monthly premiums apply for those with incomes over 188% of poverty.
See the Prescription Advantage Rate Schedule.
- Out-of-pocket expenses per member, per year, for prescriptions received under this program will not exceed $2,000 or 10% of gross annual household income, whichever is less.
Enrollment and Additional Information:
Enroll by mail. Applications available on the website www.800ageinfo.com
and soon through the CRC. For additional information contact 1-800-Age-Info (800 243-4636).
TTY (877) 610-0241.
Prescription Advantage Application and Rate Schedule
These forms are in Adobe format and require Adobe Acrobat Reader 4.0 to access them.
If you need to install Adobe Acrobat Reader 4.0, go to Start/Settings/Control Panel/Add-Remove Programs/select 'Adobe Acrobat Reader' and press Install. For further assistance, please contact Joscelyn Ruelle-Kersker x6-8182 or Ellen Forman x6-5807.
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