Prescription Drug Assistance

 

As of January 2006, Medicare began offering coverage for prescription drugs, both generic and brand name, through Medicare prescription drug plans. Consequently, some of the resources that used to be available to pay for prescription drugs are either no longer available or have changed requirements.

Many seniors are enrolled in a Medicare Part D Prescription Drug Plan. When the Plan does not pay, an enrollee may then utilize other forms of cost saving for the purchase of prescription drugs.

Some prescription drug discount programs work with the Medicare drug benefit (Part D). According to the Medicare Rights Center, if a program is a:

certified charity, the program will generally work with Part D and the amount the charity pays for your drugs will count towards your Part D plan’s catastrophic coverage limit.

drug discount program, you can often be enrolled if you have part D, but you generally only use the discount card when you are not using your Part D coverage (for example, for off-formulary drugs, drugs that are excluded from Medicare coverage by law, or during your plan’s coverage gap). The discount from your card will not count towards your Part D plan’s catastrophic coverage limit.

federal program, in most cases it will be as good as or better than the Medicare prescription drug benefit (“creditable”). If your coverage is creditable, then you do not need to sign up for Part D (although you can).

state program, you must generally enroll in Part D in order to keep this coverage. Your Medicare drug plan will serve as your primary drug coverage. In some cases, the state program will wrap around this program by paying for additional drugs or out-of-pocket costs. You will need to check with the program in your state to find out how it will work.

 

 

 

 

 

 

Active or Retired Military

The Department of Defense offers health care benefits to retired military personnel. Retirement from the military is usually after twenty or more years of service or due to disability caused by military service. Retired military personnel are veterans but not all veterans are retired military. To follow is information on a prescription benefit for active and retired military and their dependent family members.

The TRICARE Pharmacy Program allows eligible beneficiaries to obtain low-cost prescription medications from the National Mail Order Pharmacy and TRICARE network and non-network civilian pharmacies. It is important to remember that Medicare-eligible beneficiaries, who turned 65 on or after April 1, 2001, must purchase Medicare Part B. Those beneficiaries, who turned 65 years of age prior to April 1, 2001, are not required to purchase Medicare Part B.

TRICARE is the military healthcare system and can be reached at 1-877-363-6337. To use the program, every person must be enrolled in the Defense Enrollment Eligibility Reporting System. Co-payments or cost shares vary with each option and type of drug (brand name or generic brand).

If you are eligible for TRICARE benefits and you are the caregiver of dependent parents and/or parents-in-law, they will be eligible for this program if they meet all the requirements.

If prescription drugs are needed for a dependent parent or parent-in-law, they may also need primary care. TRICARE offers this benefit as well.

"Dependent parents and parents-in-law are eligible for care in a military treatment facility (MTF) and may enroll in TRICARE Plus based on space/resource availability. TRICARE Plus is a local MTF-based primary care enrollment program that may provide TRICARE-eligible beneficiaries, who are not enrolled in Prime, an opportunity to enroll with their local MTF for primary care services. Dependent parents and parents-in-law are not eligible for TRICARE Prime, Standard, Extra or TRICARE For Life. They may be eligible for the Pharmacy Program."*

*TRICARE

 

 

AIDS Prescription Drug Assistance Programs

Some state Health Departments offer prescription drug assistance for AIDS patients. Contact your local Health Department to determine if this benefit is available in your area.

The AIDS Treatment Data Network is a non-profit organization that provides case management, HIV and Hepatitis treatment and care, support, counseling, and other services for those diagnosed with AIDS. There is no fee or donation required to receive services. 800) 734-7104

 

 

Benefits CheckUp RX

The National Council on Aging is a private, nonprofit association of some 3,500 organizations and individuals. Two free services they provide are Benefits CheckUp and Benefits CheckUp RX.

Benefits CheckUp is an online service to screen for federal, state and some local private and public benefits for older adults (ages 55 and over). It provides a detailed description of the programs, local contacts for additional information (typically the addresses and phone numbers of where to apply for the programs), and materials to help successfully apply for each program.

BenefitsCheckUpRx service will provide you with a confidential, personalized report of public and private programs that can help you save money on prescription drugs. Some basic information will need to be provided for the service to work.

 

 

Co-Payment Assistance

Some people have expenses such that even paying the co-payments present a hardship. There is limited help available.

Some state pharmacy programs pay co-pays. Typically this assistance if for individuals who are Medicaid eligible.

The Patient Advocate Foundation's Co-Pay Relief Program(CPR) provides direct co-payment assistance for pharmaceutical products to insured Americans who financially and medically qualify. They do accept Medicare Part D beneficiaries who require assistance with their pharmaceutical co-payments. 1-866-512-3861 The Patient Advocate Foundation is a non-profit that provides free professional case management services to Americans with chronic, life threatening and debilitating illnesses. The case managers serve as active liaisons between the patient and their insurer, employer and/or creditors to resolve insurance, job retention and/or debt crisis matters as they relate to their diagnosis and treatment. 1-800-532-5274

Veteran's have capped out-of-pocket co-pay expenses and there are criteria used for either reducing and/or eliminating co-pays under specified circumstances. Contact the VA for more information.

 

 

Medicaid

Medicaid is a state and federally funded medical assistance program for people with low incomes. Eligibility and services vary from state to state and may change from time to time.

Medicaid offers the Pharmacy Plus Demonstration program which extends pharmacy coverage to certain low-income elderly and disabled individuals who are not otherwise eligible for Medicaid.

 

 

Membership Programs

Membership programs vary in what they offer. They may offer discounts on prescriptions, hearing aids, vision care, and/or other healthcare needs. An annual fee is charged. Typically these are programs offered to specific groups such as AARP.

Be sure to evaluate a plan before joining. Decide if it makes sense for you and whether you will actually save money over time.

 

 

Rare Disorders Prescription Assistance

The National Organization for Rare Disorders assists uninsured or under-insured individuals suffering from rare disorders to secure life-saving or life-sustaining medications. Eligibility is a sliding scale based on income.

 

 

State Assistance Programs

State pharmacy assistance programs may offer assistance in one of following ways:

• Paying the Part D premium
• Pay the deductible and/or co-pays
• Pay prescription drug costs in the doughnut hole
• Pay for drugs not covered by a plan
• Cover drugs not covered by Part D

Each state program will determine whether or to what extent it will do any of these.

Remember, if you need assistance accessing affordable prescription drugs even if you have Medicare or Medicaid, contact your local Human Services agency. They should have the most updated information on what is available and how to access it.

 

Some state assistance programs provide “wrap around” benefits.  Generally, this means they combine a set of federally-funded benefits with another package of state-funded benefits, enabling the enrollee to pay lower out-of-pocket charges for prescriptions than with the federal program alone, or to receive a type of drug not available through Medicare. Use the list below to see what is offered or contact your State Insurance Information Program

 

 

Veterans

If you are a veteran (not retired military), you may be able to have your prescriptions covered through the Veteran's Administration if they are prescribed by a Veteran's Administration physician (877-222-8387).

If you are totally and permanently disabled due to your service, health care benefits may be available for your spouse and dependent children through the ChampVA program. Check with your local VA representative.

MyHealtheVet is a one-stop-shopping portal for VA benefits, special programs, health information and services, and health assessment tools. A voluntary portion of the site allows Veterans to store health information and to allow access to specified individuals.

Veteran's may be eligible for reduced or eliminated co-payments under certain circumstances. Check with the VA to see if you qualify.

 

 

Your Doctor

Your doctor can be of great help in dealing with the high cost of prescription drugs. With the Medicare Prescription Drug Plan, most seniors now have the option to join and benefit from prescription drug coverage. However, some individuals may choose not to join. And, in some instances, Medicare does not cover either some or all prescription drugs. The suggestions below are for those times.

The following are ways your doctor can assist you:

Some pharmaceutical companies offer discounted or free medications to qualified recipients. Some of these companies only allow you to apply through your physician. Discuss your needs with your doctor to see if he or she can help.

Ask for samples of medications.

If you are getting a new prescription, only partially fill the prescription to see if the medication agrees with you.

Ask your doctor if the medication prescribed is available as a generic drug and if that would be an option for you. Generic drugs are less expensive.

Some people buy their medications outside the United States where prices are often a lot less expensive. Discuss this with your doctor to see if this would be a reasonable option for you.

Have your doctor review all your medicines to see if you still need them all and to see if there may be interactions when taking them together.

Talk to your doctor about prescribing a larger dosage of medication which could then be split. Sometimes, the larger dosage is a lot less expensive. There are caveats however. Some medications cost the same regardless of dose; some medications should not be split (it lessens their effectiveness); some are time released; and, you may not remember to split the medication and you could overdose. So, be very careful in evaluating this potential option. Get your doctor and pharmacist to approve.

If you are having trouble paying for your medicine and a generic version is not available, ask your doctor if there is another less expensive brand that would work just as well.

 

Your doctor is probably familiar with all the cost saving techniques available. Talk to your doctor openly and honestly. He or she may be able to help you more than you think.

 

 

Drug Safety

The prescription drugs you take may interact with each other, with over-the-counter medications, with herbal supplements, and with food and beverages. If you have more than one doctor, you could be putting yourself at risk if all your doctors are not informed of all the medications you take. Make a list of all your medications, the dose and frequency, and what you take the medicine for. Be sure to share this information with all your doctors. Your dentist may need to have this information as well. Be sure to ask.

 

When you have your prescriptions filled at different pharmacies, the pharmacist is not able to review all your medications for interactions. Your pharmacist may not ask about herbal supplements or food items that you use. Again, this could put you at risk.

Below you will find links to information that will help you prevent such interactions.

 

 

Ombudsman Newsletter on Medications

Triangle J Area Agency on Aging's Ombudsman Program publishes a quarterly newsletter highlighting items of interest to residents and caregivers of residents in long-term care facilities - assisted living or nursing homes.

 

In one of their newsletters, information on medications is provided. The Table of Contents and a link are provided below. Even though it was written in 2002, the information is still valid.

Ombudsmen Newsletter Contents Medications and Falls, by Frank Hielema, PhD, PT Prescription Drug Costs “Polypharmacy” The Down Side Of Keeping Your Teeth How to Talk With the Doc About Meds Prescription Drugs: Protection? or Disaster! Dosing: Do It Right! Wisdom From the Front Lines Medication Changes, Choices, & Communication A Note From the Ombudsman “Why I Work at IHS” In order to view this newsletter, you will need to have the Adobe Acrobat Reader installed on your computer. This free download is available below. This reader will also let you print the newsletter. Click below to get the reader.

 

 

What to do if You Cannot Pay for Your Medications

Paying for medication is a major expense for many older adults. If you have tried the various suggestions above, there may be legal remedies available through Consumer Law. The National Consumer Law Center, a non-profit existing on private donations, has compiled information on possible options for older adults who find they cannot afford the prescription drugs they need.

They give suggestions on what to do before you are sued and what to do if a suit has been filed. Though written in a format for advocates, caregivers can certainly make use of the information to assist a family member in this situation.

They also offer many links to sites offering information and assistance in this area.

 

There is another resource available to people who find themselves in trouble financially due to the costs of medical care.

The Patient Advocate Foundation is a national non-profit organization that provides free professional case management services to Americans with chronic, life threatening and debilitating illnesses. The case managers serve as active liaisons between the patient and their insurer, employer and/or creditors to resolve insurance, job retention and/or debt crisis matters as they relate to their diagnosis and treatment. 1-800-532-5274

They also have a Co-Pay Relief Program providing direct co-payment assistance for pharmaceutical products to insured Americans who financially and medically qualify. They do accept Medicare Part D beneficiaries who require assistance with their pharmaceutical co-payments. 1-866-512-3861

Their publication, National Financial Resources Guidebook for Patients: A State by State Directory, provides information for patients seeking financial relief for a broad range of needs including housing, utilities, food, transportation to medical treatment, and children's resources. They also offer other guides to help you understand how medical and disability systems work.

 

 

Home Delivery of Prescription Drugs by a Pharmacy

As a caregiver, you may not have time to continually go to the pharmacy to purchase needed prescription drugs. This is especially true if the drugs are only allowed to be purchased one month at a time, there are multiple drugs involved, and the timeframes for the allowed purchases are staggered. Plus, your caregiving responsibilities take up a lot of time.

If you aren't purchasing the prescriptions online, ask your local pharmacist if they have delivery service and, if so, if there is a charge.

 

 

Web Resources - Other

Buying Medicines and Products Online
a part of the US Food and Drug Administration site offering information about how to safely buy medicines online, what questions to ask and what to look out for.
(1/2008)

 

Copyright © 2001-2008, Triangle J Area Agency on Aging