Health Care Coverage
Medications/Prescription Drugs
Does your client qualify for any of these programs?
Other programs and resources for prescription Drug coverage for the uninsured or underinsured are below:
SECTIONS (click to jump there):
See also: Partners Social Determinants of Health handout- briefoverview, but available in Spanish, Portuguese, Chinese, Arabic and Russian. See CARMA then Social Services/Community Resources
Prescription Advantage
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Prescription Advantage |
Administration |
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Contact |
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Description |
Insurance plan |
Eligibility |
Enrollment is now open year-round! No need to wait for an open enrollment period!
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Income |
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Age/Disability |
65 or older or disabled |
Citizenship |
No immigration status requirements |
Other criteria |
Must be MA resident; If have Medicare must purchase Medicare D and apply for Low Income Subsidy if eligible. |
Benefits |
Primarily now a supplement to Medicare D- offering assistance in the “donut hole” coverage gap. |
Fees/costs |
- Covers Medicare drug plan monthly premium for members below certain incomes
- Members with income between 300-500% Federal Poverty Level will pay an annual enrollment fee
- No monthly premium is required for those who use Prescription Advantage as their primary coverage. However, members will pay a quarterly deductible and co-payments until an annual out-of-pocket spending limit is reached. At that time, Prescription Advantage will pay the full cost of the member’s covered prescription drugs through the end of the plan year
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Pharmacies |
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Limitations |
- Prescription Advantage will not cover diabetic supplies or prescription drugs that are not covered by Medicare Part B (except for benzodiazepines)
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PHARMACEUTICAL COMPANY PROGRAMS
There are two major categories of assistance from Pharmaceutical Companies. One is commonly referred to as "Indigent Patient" programs and the other is a recent advent of discount cards for low-income Medicare recipients.
Indigent patient programs:
Generally these programs require a physician to request a supply of the medications for the patient from the pharmaceutical company.
Eligibility, application procedures and benefits vary from company to company and drug to drug. The following websites (and there are others) attempt to help streamline the process of accessing these programs.
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www.Patientassistance.com Browse through over 1,000 prescription assistance programs designed to help those in need, then manage applications.
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www.pparx.org
Includes "medical nutritionals" and diabetes supplies.
PRIVATE AND DISEASE-SPECIFIC ASSISTANCE
- MA HIV Drug Assistance Program (HDAP) 617-502-1700 www.crine.org
--This DPH funded program is available to qualified individuals with income below 500% of the Federal Poverty Level- roughly $60,700 per year. People who are undocumented may qualify if they are Massachusetts residents.
National Organization of Rare Disorders (NORD) 800-999-6673 www.rarediseases.org
--Provides a co-pay assistance programs for medications for rare diseases. Locate the applicable program and contact them.
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Good Days (formerly Chronic Disease Fund) 877-968-7233 www.mygooddays.org/
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direct and immediate financial assistance to underinsured patients with chronic
disease, cancers or life-altering conditions who cannot afford the co-payments for the expensive medications they need.
Patient Access Network Foundation (PANF) 866-316-7263 www.panfoundation.org
--Provides assistance to patients who cannot access the treatments they need due to out-of-pocket health care costs (deductibles, copayments, and coinsurance).
Apply online or by phone.
COMMERCIAL DISCOUNT CARDS
For the uninsured or underinsured who are ineligible for MassHealth or Prescription Advantage there are some commercial discount programs that might help with prescription drug costs.
Q: Will the discount card always give me the lowest price?
A: You may pay more for some brand name medicine, even with a discount, than you would pay for the generic version or you may find the medicine for a lower cost at a different pharmacy.
Q: Will all my medicines be discounted?
A: Not necessarily. This is a consideration if you are paying a fee. Contact the program to see what medicine is available before making a payment.
More Information: Free Pharmacy Discount Cards - Cost Relief or a Scam?
Some journalists and consumers have posited that an additional, if not the main, way these cards make money is by selling your personal information for marketing purposes. A couple of journalist have consulted pharmacists who said the various discount cards typically provide a price reduction of about 10 – 16% off the full retail price.
Also see description under USA Rx below to see one financial mechanism behind this type of card (i.e., who pays and who profits).
- NeedyMeds
Needymeds.org is a non-profit organization with the mission of helping people who cannot afford medicine or health care costs. Their website provides information about government run programs (federal and state), pharmaceutical company patient assistance programs, discount cards and coupons. They also have their own discount card, profits from which strengthen and support their services. More information or download a card at www.needymeds.org.
USA Rx, administered by HealthTrans, is a discount card that can be used at participating pharmacies for discounts of between 10% and 75% off retail prices for drugs and health supplies (such as smoking cessation aids and diabetes supplies). The exact discount varies, but members can look up the price and participating pharmacies online prior to going to the pharmacy. The website also claims to list lower-cost alternatives where applicable.
This is not an insurance plan, and there are no membership costs to use the card. How it works behind the scenes and who pays is complex . Here’s the money trail: pharmacies pay a pharmacy benefit manager (PBM) to be listed in the network (in this case USA Rx- but there are others). The PBM brokers a discounted price with the stores. The store is counting on this program driving consumers to their site and is willing to offer a loss-leader in the hope that the consumer will make additional purchases. The PBM then sends a payment to National Benefits Builders, Inc. (NBBI). Then a card distributor purchases cards and distributes them widely. This distributor then gets paid from NBBI every time the card is used to fill a prescription (75 cents per filled prescription as of April 1, 2010).
- Similar discount card - Community Assistance Program's America's Drug Card program- www.americasdrugcard.org. No fee discount card ("discount of 10% - 85%"). Check website for local pharmacy participation.
DRUG COUPONS- Now Legal in MA
BUYING MEDICATIONS FROM CANADA
- Is it Legal?
In most circumstances, it is illegal for individuals to import drugs into the United States for personal use. FDA has a policy explaining that it typically does not object to personal imports of drugs that FDA has not approved under certain circumstances, including the following situations:
- The drug is for use for a serious condition for which effective treatment is not available in the United States;
- There is no commercialization or promotion of the drug to U.S. residents;
- The drug is considered not to represent an unreasonable risk;
- The individual importing the drug verifies in writing that it is for his or her own use, and provides contact information for the doctor providing treatment or shows the product is for the continuation of treatment begun in a foreign country; and
- Generally, not more than a 3-month supply of the drug is imported.
From the US Food & Drug Administration (FDA)
- www.nabp.net The website of the National Association of Boards of Pharmacy provides a list of Verified Internet Pharmacy Practice Sites.
- BeSafeRx: Know Your Online Pharmacy is an FDA site that gives consumer tips on what to look for in an online pharmacy, and what may be indications of fraudulent claims or dangerous practices.
Pharmacies:
You can search for Canadian pharmacies online. Because only half of the online pharmacies are licensed, PharmacyChecker.com, attempts to rate them. Note: PharmacyChecker.com's revenues come from fees generated by its Verification Program, and online pharmacy information, drug price and prescription discount card listings on its site. It does not make money from the online sale of medication.
INFORMATION AND REFERRAL
- Drug coverage (Part D)
Provides information on insurance options and programs that offer discounts or free medication. This includes Medicare managed care plans, Medigap plans and pharmaceutical companies' drug assistance programs. You can search by manufacturer or disease.
- MCPHS Pharmacy Outreach Program - Toll-Free Help Line: 866-633-1617
The MCPHS University Pharmacy Outreach Program is a community service program offered by the University. They provide information that includes assistance with accessing affordable prescription drug programs through the Medicare Drug Benefit, as well as medication assistance options for other uninsured or underinsured residents of Massachusetts. MCPHS serves all Massachusetts residents free of charge.
NEWSLETTER ARTICLES
SEE ALSO:
Basic Needs/Health Care Coverage/Medigap
Basic Needs/Public Policy
Rev 12/18
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