Help Paying for Prescription Drugs

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Help Paying for Prescription Drugs

• Suburban Area Agency on Aging
• 708-383-0258
• 800-699-9043
• www.suburban-age.org
• (consumer presentation)

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Todays News

• Great news!!! Illinois leads the nation in
  prescription drug programs.
• Lots of options available to help.
• Find out which programs you may be eligible for.
• Learn if you qualify for 600 credit toward the
  cost of your drugs.
• You can sign up for programs today.

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New Medicare law

• Same basic Medicare coverage, but makes changes
• Part B deductible rises from 100 to to 110 in
  2005 (and increases each year)
• New preventive benefits
• Welcome exam
• Blood tests for cardiovascular disease
• Diabetes screening
• Prescription drugs
• 2004-2005 discount cards
• 2006 prescription drug benefits

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Medicare-approved drug discount cards

• Temporary program available now, ends December
  31, 2005
• Average savings from 10 to 25 (higher discounts
  for generics)
• Annual enrollment fee 0 to 30
• Must include this seal

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Whos eligible?

• Anyone with Medicare Part A and/or Part B
• Cannot enroll if you get prescription drugs
  through Medicaid or SeniorCare
• If in Humana Gold Plus HMO, will get the Humana
  card for free
• If living in Long Term Care facility, 3 possible
  cards available statewide

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The Medicare cards- how do they work?

• More than 40 cards offered by private companies
  and approved by Medicare
• You may enroll in only one, but
• May keep other cards you may have Blue Cross
  Members First, discount card from drug makers,
  discount store
• Each program offers different discounts, drug
  lists, and list of pharmacies
• depending on the deals negotiated with drug
  makers and pharmacies
• Each card has at least one drug in every illness
  category
• www.medicare.gov website compares cards and drug
  prices for each company

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Special assistance for Medicare consumers with
lower incomes

• If you apply by March 31 may get 600 credit to
  use toward your drugs in 2005
• Amount of credit is less if you apply later in
  the year
• Whos eligible?
• Income less than 12,569 single or 16,862 for a
  couple
• You cannot get the 600 if your drugs are paid
  for through full Medicaid, SeniorCare or an
  employer / retiree plan, but
• You may be eligible if you are on Medicaid
  spend-down or get your drugs through the VA

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If you qualify for the 600 credit

• You need to select one of the Medicare-approved
  discount cards
• Some cards offer additional savings after the
  600 is used up
• No fee for the discount card
• Medicare pays it
• 600 credit on the card
• can apply the 600 to almost any drug (not just
  those on the discount cards list)
• works like a prepaid phone card or debit card
• You pay 5 or 10 of the discounted cost of each
  prescription (depends on your income)

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How 600 credit works - example

• Mrs. R selects a card,
• fills out an application and sends it to the card
  sponsor OR
• applies directly on the internet, and
• gets approved
• Goes to the pharmacy (or sends in mail order) for
  a drug with a discounted price of 100
• presents her Medicare-approved discount card and
  pays 10 co-insurance (10)
• 90 is subtracted from her 600 credit
• 510 credit remaining
• The pharmacist or card sponsor can tell you how
  much credit is left on your card

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Variety of Other Program Options

• State
• Medicaid
• SeniorCare
• Circuit Breaker/ Pharmaceutical Assistance
• Illinois Rx Buying Club
• Federal
• Medicare
• Covered drugs
• Discount cards
• Transitional Assistance
• Veterans Administration (VA)

• Private
• Retiree plans
• Medigap insurance
• Medicare Advantage (HMO)
• Discount cards
• Patient Assistance Programs (drug makers)
• Store discount programs

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Whats the best program for me?

• Depends on your age, income, what drugs you take
  and what programs you qualify for
• The costs to you will vary widely from one
  program to the next
• Best option depends on your individual situation
  and preferences
• Could be a combination of programs

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Medicaid

• Persons over 65 or disabled or blind, any age
• Drug coverage and medical services
• Income less than 776 single or 1,040 married a
  month
• Asset limit is 2,000 individual and 3,000
  couple, not including car or home
• Drugs cost 0 generic or 3 brand name

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State Programs -SeniorCare or Circuit Breaker

• One application for both programs
• State decides which one you qualify for
• If you are eligible, often better deal than any
  discount card
• You must re-apply every year

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Circuit Breaker/Pharmaceutical Assistance

• Age 65 years and over or on disability (age 16 or
  over)
• Pays for medications for 10 specific illnesses
• Alzheimerss
• Arthritis
• Cancer
• Diabetes
• Glaucoma
• Heart and blood pressure problems
• Lung and smoking-related illnesses
• Multiple sclerosis
• Osteoporosis
• Parkinsons disease

• Income Eligibility Less than
• 21,218 single
• 28,480 married
• Cost?
• 5 or 25 to apply (per year)
• 3 per generic drug
• Brand name 3 plus difference
• Pays up to 2,000
• Then you pay 20

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SeniorCare

• Age 65 years and over
• Covers 97 of all medications
• Covers some prescribed over-the-counter drugs
• Income Eligibility?
• 19,140 single
• 25,660 married

• Costs?
• No fee to apply
• 1 generic
• 4 brand name
• Pays up to 1,750
• Then you pay 20
• 25 per month stipend instead of SeniorCare
  benefits if you already have insurance coverage
  for drugs

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Illinois Rx Buying Club

• 10 fee
• 10-30 discounts on medications with volume
  buying from state
• Circuit Breaker enrollees receive card for free

• New state discount card program started in
  January 2004
• Open to all 65 and over and on disability
• All prescription drugs approved by FDA included

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I-Save Rx

• Developed by State of Illinois allowing consumers
  to purchase refills from Canada and the United
  Kingdom
• Can save 25-50 off retail
• No fee to apply
• Must enroll first with 3 months prescription
• Medications sent and they call 1 month prior to
  refill date
• Call 1-866-472-8333 for information

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Veterans Administration

• Veterans may be eligible for drug benefits from
  Department of Veterans Affairs (VA)
• Veterans must enroll with the VA and be seen by a
  VA physician once each year
• Income less than 24,644 for single (for new
  enrollees)
• Co-pay 7 for 30 day supply (may go up)
• Any questions? Call 1-877-222-8387

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Other Ways to Pay for Medications

• Patient Assistance Programs from drug companies
  through PhRMA
• Patients need authorization from their doctor
• www.helpingpatients.org
• Drug company discount cards (like Together RX
  Card)
• Ask doctor for samples and talk with them
  honestly about your ability to pay for
  medications
• Purchase on the Internet
• www.DestinationRX.com- compares drug prices on
  web
• Larger chain/discount stores
• Larger quantities - 90 days supply not 30
• Cut in half larger dose (when safe to do)
• Generic medicine

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Fill Out a Benefits CheckUp

• One place for information on all Rx programs
  (Medicare, state and others)
• Find out which programs you qualify for
• Prescription drug and hundreds of other state,
  federal and local programs
• Identifies best prescription drug saving program
  (or programs) for you
• Learn where to apply and what you will need
• Get help from the agency near you or or go to
  www.benefitscheckup.org or
• www.accesstobenefits.org

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Act Now!

• You will benefit from applying for programs
  before March 31!
• Get the full 600 credit from Medicare approved
  cards
• Re-apply for Circuit Breaker/ SeniorCare and
  avoid a break in coverage in June
• Enroll in other programs (like Medicaid or
  Medicare Savings Programs) and it will be easier
  to get your benefits for 2006

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Need help deciding or applying?

• There are people to help!!!
• HealthCare Choices Resource Center (suburban
  Cook)
• 1-800-789-0003
• Chicago Department on Aging (Chicago)
• 312-744-4016
• SHIP counselors (Illinois)
• 1-800-548-9034
• Help with Illinois Programs
• Senior Help Line (IL Dept on Aging)
• 1-800-252-8966
• Elder Care Locator (anywhere in the US)
• 1-800-677-1116

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Medicare Prescription Drug Program in 2006

• Will be offered by private plans contracting with
  Medicare
• You will have 2 kinds of plans to choose from
• a plan that only covers drugs or
• a managed care plan (HMO or PPO)
• Plan choices will be announced in October 2005
  you may enroll beginning November 15
• If have coverage (like retiree) thats as good as
  the Medicare plans, will be able to stay in it

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Benefits for 2006

• You may have heard about the standard plan
• Average monthly premium expected to be around 35
  420 per year
• 250 deductible (you pay)
• Between 250 and 2,250 in drug costs, the plan
  pays 75, you pay 25
• Between 2,251 and 5,100 you pay all no
  benefit--DONUT HOLE or 3,600 out of pocket
• After 5,101 program pays 95
• But plans may look different - other benefit
  designs are expected

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Help for people with lower incomes in 2006

• Help will be available depending on your income
  and assets
• If you qualify, no gaps or donut hole
• 2-step process
• 1) enroll in the help program in the spring or
  summer and
• 2) select a drug plan in the fall
• Some people will be automatically enrolled in the
  programs
• If you are likely to qualify, you will receive
  letters from Social Security or Medicare
  explaining what to do watch your mail
• Benefits will become effective in January 2006

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Scam Artists Are at Work

• People are so confused by new programs that it
  breeds fraud
• Reports from several states including Illinois!
  
• Selling discount cards door to door
• Charging large amounts to help apply
• Selling fake cards
• Calls asking for personal information
• Offers to help sign up for new Medicare benefit
  (not available yet)

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Dont Be a Victim!!!

• If it seems too good to be true, it probably is
• Dont give out your Medicare or Social Security
  number unless you know who you are dealing with
• Report any suspicious marketing practices

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Dont hesitate to ask for help

• Trained counselors are available to help you
• figure out what you are eligible for
• select the best program for you
• enroll in whatever you choose
• To find the help nearest you, call
• HealthCare Choices (Suburban Cook)
• 1-800-789-0003
• Chicago Dept on Aging (Chicago)
• 312-744-4016
• Northeastern Illinois Area Agency on Aging
  (collar counties)
• 1-800-528-2000
• SHIP program (Illinois)
• 1-800-548-9034
• Medicare at 1-800-medicare