Lowering the Cost of RX Drugs

LOWERING THE COST OF RX DRUGS

Prevacid to treat your heartburn, $161; Celebrex for your muscle pain, $104; Zocor to combat high cholesterol, $120 … the next time you're at your local pharmacy calculating these costs for just a one month supply of your prescription drugs, know that lower prices may be on the way. Last year the President signed into law the Medicare Prescription Drug, Improvement and Modernization Act of 2003, bringing sweeping reform to an antiquated system desperately indeed of an overhaul. The marquis provision of the legislation was a prescription drug program, which will go into effect on January 1, 2006. But Texas seniors don't have to wait until then for relief.

Starting this June, seniors can receive a discount card that will provide them with access to negotiated prices on prescription drugs. Enrollment is now open for the cards that will expire in 2006 when the more comprehensive Medicare benefit takes effect. More than 2.3 million Texans are currently Medicare participants, but a quarter of those beneficiaries do not have any prescription drug coverage. This program primarily benefits them by helping pay for the lifesaving drugs they need. Medicare estimates seven million beneficiaries, including 497,000 in Texas, will participate in the program. If participation reaches those levels, it will mean a potential savings of $8.6 billion nationally and $596 million for Texans.

Who is Eligible?

The cards will provide a $600 annual credit to eligible low-income Medicare beneficiaries. Individuals whose income is less than $12,569 each year or married couples whose income is less than $16,862 may qualify for this additional help. Those with outpatient prescription drug coverage through TRICARE, FEHBP or other employer sponsored drug plans will not be eligible for the $600 credit. Medicare will cover the cost of the enrollment fee for these low-income cardholders and the Department of Health and Human Services will work aggressively to reach eligible low-income beneficiaries and enroll as many as possible in the new program.

Texas has 46 individual drug cards, including 39 national drug cards, four regional cards, and three Medicare Advantage exclusive cards. Using only their zip code, seniors can obtain information on plans available in their area, compare prices for drugs and identify pharmacies associated with the available card programs.

How to Choose a Discount Drug Card

This program offers a wide range of choices, which can a mixed blessing. Numerous options enable Texans to find the card that best fits their needs, but it can also make for a confusing decision process. I encourage Texas seniors to do their research and take advantage of the right plan for them, because the choice they make now will last through the end of the year. Following these simple instructions will help:

1. Eligible beneficiaries will be limited to one Medicare-approved card. Toll-free operators and Medicare's Web site will assist seniors in selecting which card best fits their needs. (See below for contact number.)

2. Before calling or applying online, seniors should make a list of the medicines that they take regularly as well as financial information to determine if they are eligible for the $600 credit.

3. Medicare then will help seniors compare prices among cards, taking into account factors like frequency of medicines taken, possibility of generic substitutes, as well as preference for a local pharmacy or mail order depending on convenience concerns.

4. Once seniors have selected a card, they should request an enrollment form from the card sponsor. Card providers may charge an annual enrollment fee up to $30. However, many sponsors have opted to waive the fee or have reduced its price. In addition, there is no enrollment fee for those beneficiaries for the $600 credit.

5. Most importantly, seniors should always look for the "Medicare-approved" seal when receiving their card in the mail.
For help in comparing options or finding out how to enroll in the discount card program, Texans should call 1-800-MEDICARE and ask about "drug savings" or visit the information superhighway at www.medicare.gov and select "Prescription Drug and Other Assistance Programs."