Programs Help Pay Drug Costs
Authored By: Legal Hotline for Older Iowans
Are you having a hard time paying for your drug costs? There are a number of programs that may be able to help you.
Patient Assistance Programs
Many drug companies give free or low cost prescription drugs to needy people. Each company sets up their own rules of eligibility. You may be eligible for some programs but not for others. There is a Directory which lists the available drugs and each company's rules of eligibility. You can get copies of this Directory by calling the Legal Hotline for Older Iowans at (800) 992-8161 or from the makers of the Directory, Phrma, at (800) 762-4636. Helpful information is also available on the internet at www.needymeds.com and www.helpingpatients.org.
If the Directory lists a company that makes one of your drugs, you should request an application from them. Some programs say your doctor must ask for the application. If this is the case ask your doctor to do this for you. Both you and your doctor will have parts to fill out. Have your doctor's office help you file the application when it is complete. If you are eligible, the company will send the drug to either you or your doctor.
Medicare Prescription Drug Discount Cards and Transitional Assistance Program
Medicare provides these two programs until the new Medicare drug benefit starts in January 2006. The eligibility for the two programs is different. For the Drug Discount Card you must have Medicare Part A or Part B. Also, you must not have prescription drug coverage through Medicaid. For the $600 per year in Transitional Assistance you must be on Medicare Part A or Part B. Also, your household income cannot be more than $12,569 (single) or $16,862 (married). Finally, you must not have prescription drug coverage through Medicaid, TRICARE, the Federal Employee Health Benefit Program (FEHBP) or through other health insurance, including an employer or retiree plan.
There are many things to think about when you apply for a card. First, you can usually join only one discount card each year. You can choose one card now for 2004. You will be able to choose a new card for 2005 between November 15 and December 31, 2004. Second, companies choose which drugs will be discounted and how much they will be discounted. They can also change their drug list and prices anytime. Third, the discount cards cannot be used for drugs covered by Medicare. Fourth, only some pharmacies will honor the card you choose. Other pharmacies will not give you the discount. Finally, companies are allowed to charge you a yearly fee. At most they can charge you $30. For help in applying for the best card for you call SHIIP at (800) 351-4664. You can also call Medicare at (800) 633-4227 or go online at www.medicare.gov.
When applying for the drug discount card you may also apply for the $600 in transitional assistance. When you ask for an enrollment form simply ask for the assistance as well. You fill out the form and send it to the company. The company then sends it to Medicare. If you qualify, Medicare will apply up to $600 to your discount card. They will also pay the annual fee for your discount card.
Note To Nursing Home Residents
Medicare treats nursing home residents differently under these programs. Private pay residents can still get a regular Medicare Drug Discount Card, but might be unable to use it. Nursing homes may require you to buy pre-packaged drugs at a specific pharmacy and most pre-packaged pharmacies will not accept the card. Transitional Assistance is available to nursing home residents who meet the above income guidelines and do not have other drug coverage, including Medicare Part A or Medicaid. There are only three or four cards to choose from. These cards provide the $600 transitional assistance but no drug discount.
Pfizer and Eli Lilly "U Share Card"
Pfizer and Eli Lilly offer a Medicare card with flat-fee pricing for many of their own drugs. A person on this card who receives the $600 transitional assistance will first pay 5-10% of the cost of drugs made by these companies. The other 90-95% of the cost will be taken out of the $600 until this money is used up. Medicare will pay for the cost of the card. After the assistance is spent, the person will then pay a flat-fee of $15 for a 30-day supply of many Pfizer drugs or $12 for a 30-day supply of many Eli Lilly drugs. The cost of other drugs covered by the card varies. People will generally save 10% on these drugs. People who cannot get the $600 assistance but have an income below $18,000 (single) or $24,000 (married) will pay the discounted price from the start. People over these income limits will not be eligible for the flat-fee discounts. However, they may still qualify to save 10% or more off of drugs covered by the program.
Supplemental Drug Discount Plans
The drug discount cards described below supplement the Medicare-approved drug discount cards. This means that you can have one or more of these cards in addition to a Medicare drug card. These companies will likely end their programs when the new Medicare drug benefit starts in 2006.
GlaxoSmithKline PLC has the "Orange Card." This card gives a discount of 25% off drug prices at certain pharmacies. The annual income limits are $26,000 (single) and $35,000 (married). Medications include Advair, Flonase, Paxil and Zyban. For an application call (888) 672-6436.
Together RX is an alliance of eight drug companies. (Abbot Laboratories, AstraZeneca, Aventis, Bristol-Meyers Squibb, GlaxoSmithKline PLC, Jansenn, Novartis AG and Ortho-McNeil). Their discount card is available for people whose income is less than $28,000 (single) and $38,000 (married). You can save 20-40% off the name-brand drugs of these companies with this card. You can also save 15% off the price of generic drugs at participating pharmacies. For an application call (800) 865-7211.
For more information about these drug discount plans and other programs that help older Iowans, please call the Legal Hotline for Older Iowans 1-800-992-8161.