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Getting the Most from the Medicare-Approved Drug Discount Card: Time is of the essence to help low-income seniors gain maximum savings

If your loved one or patient is currently enrolled in Medicare, it is important that you take the time this month to find out about options through the Medicare-Approved Drug Discount Card.

The card, which launched in June of this year, is available to any Medicare beneficiary who does not have prescription drug coverage. However, the Medicare card is most helpful to low-income seniors whose income is less than $12,569 for an individual or $16,862 for a married couple (<135% federal poverty level). The open enrollment period for selecting a Medicare card ends December 31, 2004, which is why now is an optimal time to help low-income seniors sign up for a Medicare card. Note that this article uses the term “seniors” to refer to all Medicare beneficiaries, recognizing that although people over age 65 represent more than 85 percent of the Medicare population, almost 5 million younger, disabled people are also covered by Medicare.

Seniors and caregivers have many questions about the Medicare card, so in this article you will find several topics that address some of the most common questions: What is the annual $600 transitional assistance credit and how does it work? What kind of additional savings do seniors get through the manufacturer “wrap-around” programs? How can a senior enroll and by when do they need to? Can a senior continue to use a patient assistance program if they enroll in a Medicare card?

Transitional Assistance Credit – Up to $1200

In addition to the savings offered by the pharmaceutical manufacturers, low-income seniors may qualify for a transitional assistance credit from the federal government. This credit provides a beneficiary up to $1200 to use towards the cost of their prescription medicines between now and the end of 2005. And, if they qualify for that credit, there is no annual enrollment fee for the Medicare card.

In order to get the $600 credit for 2004, a senior has to sign up for a card prior to December 31, 2004. Any remaining portion of the credit that is not used in 2004 carries over into 2005. Then, in 2005, an additional $600 is added to the senior’s transitional assistance credit.

For example, if a senior uses $100 of the $600 credit in 2004, $500 carries over into 2005 and gets added to the $600 credit for 2005 – giving the senior a credit of $1100 to use towards prescription medicines in 2005.

For those who miss the December 31 deadline, they can still enroll in a Medicare card in 2005, but they will lose the $600 credit for 2004. If a senior applies for the $600 credit for the first time during 2005, the completed enrollment form must be received in the first three months of the year for the senior to receive the full $600 credit. If a senior applies later in the year, he or she will not get the full $600 credit. The chart below shows how much a senior will get depending on when he or she joins in 2005:

If You Join Between… You Will Receive…
January 1 – March 31, 2005 $600 credit
April 1 – June 30, 2005 $450 credit
July 1 – September 30, 2005 $300 credit
October 1 – December 31, 2005 $150 credit
“Wrap-Around” Programs Offer Additional Savings

If a patient qualifies for the transitional assistance credit, they should consider selecting a Medicare-Approved Drug Discount Card Program that offers a Medicare Assistance Program (MAP; also known as a “wrap-around” program).

Offered by pharmaceutical manufacturers, the wrap-around programs provide additional savings once the patient uses all of their transitional credit. If an enrolled beneficiary is eligible, he or she is automatically enrolled in that company’s MAP once the $600 credit is spent. The patient then pays only a small fee (up to $15 a month per prescription) plus the pharmacy’s dispensing fee. More than 200 drugs are available through these MAPs, including some of the drugs most commonly prescribed to seniors

For more information about MAPs, including a list of the discount cards participating, a list of drugs available, and eligibility criteria, visit www.cms.hhs.gov/medicarereform/drugcard/mfragreements.asp

How to Enroll

Medicare Call Center and Website

To enroll in a Medicare-Approved Drug Discount Card, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. When you call, have the following information ready:

Your Zip code

Your medicines and doses (you can find this information on your pill bottles)
The name of the manufacturer of your prescription (you can often find this information on your pill bottles)

The name of your preferred pharmacy, and
Your total monthly income (if you are interested in the $600 credit and wrap-around savings programs)

PAPs Remain Viable Options for Low-Income Seniors

Another option lies with the charitable programs (often called patient assistance programs or PAPs) that most drug companies offer to low-income patients without prescription drug coverage. These programs are open to patients without insurance that covers their medications, which includes Medicare beneficiaries until the Part D benefit becomes available on January 1, 2006.

One advantage of these programs over MAPs is that they generally have more generous income guidelines, which vary by program but are often as high as 200% of the federal poverty level. Another advantage is that medications are usually provided at no cost. More than 800 drugs are available through PAP program, including the large majority of brand-name medications and some generic medications.

For more information about pharmaceutical manufacturer PAPs and to get application forms, visit www.pparx.org or www.rxassist.org.

For More Information

The Medicare website (www.medicare.gov), the official U.S. government site for people with Medicare, offers information on the Medicare-approved discount cards, including tools that patients can use to help them locate the care best suited to them. This site includes a “Features” section that provides information about expanded Medicare Assistance Programs. Providers and advocates will likely have to help low-income patients select the option that is best for them using Medicare.gov or another resource.

Some pharmaceutical companies have participated in efforts to provide answers about the Medicare card and disseminate information to community health professionals. In a telebriefing and webinar presented by AstraZeneca in late October, representatives from CMS, AARP, Medicine for People in Need (Medpin) and the Cleveland Department of Aging shared information and lessons learned to aid in education and enrollment efforts. Any community health professionals interested in receiving a transcript and Q&A from this telebriefing may contact Karissa Laur, Senior Manager of Corporate External Relations at Karissa.laur@astrazeneca.com or at 302-886-4214.
 

Kathryn Saenz Duke, JD, MPH
Program Director, Medicine for People in Need (MedPin)

Stephanie Geller, EdM
Research Director, Volunteers in Health Care
 

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