ELIGIBILITY
The SPP has raised the income eligibility guideline from 150% of the Federal Poverty Level to 188% of the FPL. This change translates to a new yearly income cap of $15,492 per year for an individual. Moreover, patients with limited coverage for prescriptions through a Medicare replacement policy may now also access the SPP benefit.

Previously designated for the over 65 population, the Senior Pharmacy Program will also provide medication benefits to the disabled. Disabled patients who do not have Medicaid may enroll in the SPP if they work less than forty hours per month. The disability requirements for the SPP follow closely to those for MassHealth CommonHealth.

The Senior Pharmacy Program will also provide short-term catastrophic drug coverage for patients with an income up to 500% of the FPL ($41,200/year). To qualify for catastrophic drug coverage, the senior or disabled patient would have to have spent at least ten per cent of his/her income on medication costs over a six month period. This provision will be in place from January 1, 2000 until December 31, 2000. A long term catastrophic drug program is to be announced this coming April.

BENEFITS
Under the revised program participants will receive $1,250 in medication coverage per year, a $500 increase from the 1999 benefit amount.

Patients must pay either a $3 co-pay for generic drugs, insulin, and disposable syringes, or a $10 co-pay for brand name medications. A $15 enrollment fee is also deducted from the $1250 allotment at the time of enrollment.

The Senior Pharmacy Program provides MassHealth approved medications from each of the Therapeutic Classes. In order to find out if a particular medication is covered by the SPP, one should call the program directly at 1-800-953-3305, or TTY:1-800-813-7787.

ADVOCACY TIPS
Since the program does not take into account a patient’s assets in determining his/her eligibility, the SPP can assist elders on a fixed income who have accumulated resources. Furthermore, the program allows a patient to apply either as an individual or as part of a couple, whichever presents a more favorable picture for the client.

APPLICATIONS
The new Senior Pharmacy Program applications have been ordered by Patient Financial Services and the CRC. In the meantime, one may use the current application. SPP will distribute enrollment packets in the near future, and will be equipped to answer questions with regard to details about the expanded program. The CRC will keep you updated with information as it becomes available.

BACKGROUND
The State of Massachusetts established the Senior Pharmacy Program in 1996 to help the elderly who are ineligible for Medicaid with the cost of prescription drugs.

The State Legislature expanded the SPP by increasing its budget from $30 million to $51.7 million per year. According to Representative

Harriet Chandler (D-Worcester), the SPP spent under-budget in providing only approximately $16 million in benefits to 26,000 seniors in the previous year of operation. Representative Chandler cited a need for increased outreach efforts to enroll more patients. Other reasons for the SPP expansion include reactions to recent health care trends which have affected Medicare recipients. Last January, a federal court ruled that Medicare HMO companies are not required to provide unlimited prescription drug coverage to patients. The most comprehensive Medigap (supplemental) policies prove to be prohibitive in cost to many Massachusetts residents.

FUTURE DIRECTIONS
The State will be looking into more ways to provide low cost medication coverage to Medicare recipients. One proposal is for Massachusetts to join with other states in forming an aggregate purchasing pool to negotiate prices with pharmaceutical companies. Health care advocates in the House are considering streamlining the application process for Indigent Drug Programs by offering a "1-800" number which patients could call to apply for multiple programs at once. On the Federal Level, the Clinton Administration is developing a plan to upgrade Medicare Part B coverage by the year 2001 to include $2000/year in medication benefits with no deductible. Currently, 35-45% of the nation’s 39 million Medicare recipients (34m aged and 5m disabled) lack drug coverage, while 80% of American senior citizens take at least one prescription per day.

Special thanks to Liz Gans of the Committee for Health Care, Office of the Honorable Harriet Chandler.

-Nicole Levy, Patient Financial Services