MEDICARE PRESCRIPTION DRUG DISCOUNT CARDS
The Connecticut Pharmaceutical Assistance Contract to the Elderly (ConnPACE) helps eligible persons pay for prescription medications. Those who are eligible are either aged 65 or older or aged18 or older with a disability; and have income, for 2008, of less than $23,700 if single or $31,900 if married. Additionally, eligible individuals must have less than $100,000 total countable assets if single and less than $125,000 if married.
Generally, eligible individuals may not have another insurance plan that covers a portion of the cost of prescriptions, unless that plan provides a maximum of benefits. If an individual has a plan that provides a maximum of benefits, once that person has reached the maximum of benefits, he or she may be eligible for ConnPACE. Eligible individuals may also have a prescription drug plan that only covers generic medications. Under such circumstances, ConnPACE may cover brand name medications.
To enroll in ConnPACE, eligible individuals must pay a $30 annual enrollment fee. Once enrolled, participants are responsible for a $16.25 co-payment for each prescription filled.
Medicare Prescription Drug Discount Cards
The Medicare Prescription Drug Discount Card program, in effect from June 2004 through December 31, 2005, is part of the Medicare Improvement, and Modernization Act of 2003, Public Law 108-173 (Medicare Act). Generally, Medicare beneficiaries, except those who receive prescription drug coverage via enrollment in Medicaid, may participate in the Medicare Prescription Drug Discount Card Program. Beneficiaries who wish to participate must purchase a discount card from a Medicare endorsed prescription drug card sponsor. Cards will be available for purchase in June of 2004; the annual enrollment fee cannot exceed $30.
The prescription drug discount cards will provide eligible Medicare beneficiaries with access to negotiated discount prices. Additionally, for individuals with income that is not more than 135% of the Federal Poverty level, and who do not have prescription drug coverage through Medicaid, TRICARE for life, or an employer group health plan, the program will provide up to a $600 yearly credit for the purchase of covered discount card drugs and pay the annual discount card enrollment fee.
Coordination of ConnPACE and Medicare Prescription Drug Discount Cards
To permit and encourage participation in the Medicare Prescription Drug Discount Card Program, the Connecticut legislature has made changes to the ConnPACE program which will blend the two programs for some individuals.
Due to these changes, participation in the Medicare Prescription Drug Discount program will not bar a Medicare beneficiary from participating in the ConnPACE program. However, as a condition of ConnPACE eligibility, Medicare beneficiaries with an income at or below 135% of the federal poverty level, will be required to obtain a Department of Social Services (DSS) designated Medicare Prescription Drug Discount Card. Additionally, DSS may, if it is determined to be cost-effective for the state, require that all Medicare beneficiaries who participate in the ConnPACE program obtain a Medicare Prescription Drug Discount Card.
A Medicare prescription drug discount card enrollee who is also a ConnPACE participant, shall be responsible for the payment of any Medicare prescription drug discount card coinsurance requirements, provided such requirements do not exceed the $16.25 ConnPACE co-payment. If a Medicare prescription drug discount card beneficiary’s coinsurance requirements exceed the ConnPACE co-payment, DSS shall pay the pharmacy the difference.
Example: If the prescription drug discount card coinsurance is $40.00, DSS will pay the pharmacy $23.75 ($40.00 - $16.25).
Additionally, if the cost to the beneficiary exceeds the $600 discount card credit, DSS shall make payment to the pharmacy to cover costs in excess of the ConnPACE co-payment requirements.
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