Tuesday, June 01, 2004

Prescription Drug Scam... 

I'm not allowed to tell you why, but I am an expert on the new prescription drug discount cards. There is a lot of incorrect information floating around out there. I found this Questions and Answers story today that is full of errors.
Who is eligible?

Anyone enrolled in Medicare is eligible for one of the new Medicare-approved discount prescription-drug cards.
Not true. To be eligible you must be enrolled in Medicare part A and/or B AND you cannot be receiving any prescription drug coverage from your state Medicaid program.
What do the cards do?

Medicare officials say the cards will offer savings ranging from 16 percent to 30 percent, on average, off the retail price of brand-name drugs. Larger discounts are available by ordering drugs through a card sponsor's mail-order pharmacy or by buying generic drugs.
Mail-order isn't always cheaper. It depends on the specific drugs and the card you select.
Are there special benefits for low-income Americans?

Yes. If your monthly income for 2004 does not exceed $1,047 if you are single or $1,404 if you are married, you might qualify for a $600 credit on your discount card to subsidize the purchase of prescription drugs.
It's actually $1,406 if you are married. You also cannot qualify for the credit if you are receiving any prescription drug coverage from other non-medigap insurance policies.
Are there fees involved?

Yes. Card sponsors can charge up to $30 for an enrollment fee. Low-income Medicare beneficiaries who get the $600 credit must pay a co-payment -- 5 percent or 10 percent, depending on income -- each time they make a drug purchase using the subsidy.
That's 5% or 10% until the $600 credit is gone. The $600 credit is tricky. Imagine for a moment that you qualify for the $600 credit. You are taking Lipitor for your high cholesterol. The discounted price of the drug is $100 for a 30 day supply. The pharmacy will charge you $5 for the drugs and charge the remaining $95 to the $600 credit. Once that credit is used up, you will go back to paying $100. A person taking only a few drugs can use their $600 credit in one trip to the pharmacy.
Can I switch cards whenever I want?

No. Medicare regulations stipulate that seniors who choose a card must use that card the rest of the year. Seniors may choose a different card during an open enrollment period from mid-November through mid-December, but they can't begin using the new card until 2005.
What it fails to mention is that the card companies can change their drug prices every seven days with no warning to or recourse for the beneficiary.

The program is flawed. The majority of people will receive little or no benefit from the program.

I'm happy to help anyone who needs help sorting through the mess of the program. Contact me if you or someone you know is lost or confused.