Medicare Approved Drug Discount Cards

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Medicare Approved Drug Discount Cards

• University of Nebraska
• Cooperative Extension

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Medicare Prescription Drug Improvement and
Modernization Act of 2003

• New Medicare legislation signed by President Bush
  in December 2003
• Provides prescription drug benefit
• (Medicare Prescription Drug Plans)
• Enrollment in drug plans happens November 15,2005
  May 15, 2006

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Drug Coverage Until 2006

• Medicare-approved drug discount cards serve as
  interim coverage until the prescription drug
  plans begin
• Enrollment began in May 2004
• Beneficiaries were able to start using a card
  June 1, 2004
• Voluntary program

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Discount Cards - Eligibility

• Most Medicare beneficiaries are eligible for a
  discount card
• There is NOT an asset test or income level
  requirement
• You cannot apply if you have outpatient
• prescription drug coverage through Medicaid

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600 Credit

• Up to 600 a year will be made available to
  low-income beneficiaries without any other
  prescription drug coverage

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Guidelines for 600 credit

• Income guidelines for 600 credit
• Single Person 12,919 (1077/month)
  Married Couple 17,320 (1444/month)
• Credit amount is prorated in 2005
• Enroll Jan March 600
• Enroll April June 450
• Enroll July Sept 300
• Enroll Oct Dec 150
• Unused can carry-over until May 15, 2006 or
  until your new 2006 prescription drug plan takes
  effect

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600 Credit Continued

• Coinsurance
• 5 for enrollees (798/mo. or less single
  1070/mo. married)
• 10 for enrollees (1077/mo. or less-single
  1444/mo. married)
• Tracking
• Card sponsors responsible for tracking funds,
  information on remaining amount will be available
  by calling the the Customer Service Department at
  the card sponsor

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Discount Cards - How They Work

• Each qualifying beneficiary is entitled to
• only one Medicare-Approved drug card
• Cards may save beneficiaries an average of 10-25
  on prescriptions
• Beneficiaries may pay annual enrollment fee of no
  more than 30
• Fee waived for those qualifying for 600 credit

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Discount Cards-How To Choose

• More than 36 cards are available to Nebraskans
• Does the card cover most of your medications or
  at least the most expensive ones?
• Which card gives me the best overall price on my
  prescriptions?
• Does your pharmacy accept the card?

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Formularies (list of approved drugs)

• How do they work?
• CMS requires all cards to have at least one drug
  of each type. Example osteoporosis drugs
• Two commonly prescribed drugs for osteoporosis
  are Fosamax and Evista
• Discount Card A may offer a discount on Fosamax,
  but no other while Discount Card B offers a
  discount on Evista but no other
• Beneficiary must compare which drugs are
  discounted by which companies

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www.medicare.gov call medicare at
1-800-633-4227call SHIP at 1-800-234-7119

• ? Three-Step Process for comparing cards
• 1) Enter zip code
• 2) Enter prescriptions (including strength and
  dosage)
• 3) Enter pharmacy preference
• Price comparison simplifies the selection process

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Name of Beneficiary _____________ Medicare
Number _______Address _______________________
__ City, State, Zip _________Other Insurance
Co. Name _________ Date of Birth
__________Preferred Pharmacy _______________
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Facts to Keep in Mind

• Not every beneficiary will benefit from a card,
  but potential savings are worth investigating
• Card companies can change which drugs they will
  cover
• Once beneficiaries enroll in a program, they are
  essentially locked into that card for the year

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Cards For Nursing Home

• Only 3 cards can be used for someone in a nursing
  home
• LTC Card
• Community Care Rx
• PBM card