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X : Testimony of
Kathy Copelin, Program Manager
Shasta County Health Insurance Counseling & Advocacy Program
Senior Advocacy Center of Northern California
Senate Health and Human Services Committee
February 18, 2004
Medicare Beneficiaries 65 and Over and Prescription Drug Programs
The Medicare Prescription Discount Card Program, along with the Transitional Assistance Program and the Special Transitional Assistance Program are very complicated.
Beneficiaries who sign up for these may become ineligible for pharmaceutical Patients assistance programs.
If a beneficiary takes medication manufactured by 3 or more pharmaceutical companies the issue becomes even more complex. In the Shasta, Lassen, Modoc, Siskiyou and Trinity county area, 53% of our clients in the past 12 months used three or more pharmaceutical companies. 10% of those will need to choose between 8 or more companies. And they will only be allowed to choose one card.
While a $600 pre-loaded card sounds good, for many this will only cover two to four months of prescriptions.
There are serious issues involving access for those in the rural areas, and for those with limited English proficiency.
Access to retail/discount pharmacies in the rural/frontier areas.
Access to understandable information on the programs.
Access to information in languages other than English, especially in Imperial, Los Angeles, Orange, Monterey, San Benito, Merced, Santa Clara, Alameda and San Mateo counties.
Educating and counseling Medicare beneficiaries on these programs will require an unprecedented expenditure of resources.
Funding allocated by Federal Government to CMS.
Average time it currently takes to research programs for one client with 4 medications: 2 hours.
Average time it will take for same client when considering MPDIMA: 2.5 hours.
County# 65 and over#65 and Over/Low income *#65 and over Dual EligibleLow income
Not on
Medi-CalImperial14,3058,584 (62.3%)6,8611,723Del Norte3,4481,670 (50.2%)6151,055Kern62,05429,328 (49.8%)12,68416,645Tulare35,91716,927 (49.8%)9,5447,383Merced20,0049,199 (47.6%)5,2593,940Mariposa2,9401,360 (47.1%)2551,105Modoc1,663743 (47%)228515Kings9,5574,189 (46.5%)2,2761,913Yuba6,4102,873 (45.9%)1,4261,447Siskiyou8,0403,425 (44.3%)1,0942,331TOTALS164,33878,29840,24238,057
UCLA Center for Health Policy Research Source: Census 2000
* Income at or below $24,125 for single/$32,560 couple.
Some of these beneficiaries are ineligible for Medi-Cal based on the asset limitations. For them, the Medicare Transitional Assistance Program may be helpful as there are no asset tests.
However, those whose incomes are over 135% of the Federal Poverty Level-
($12,123 for single/$16,362 for couples) will not be eligible for the TAP.
There are other programs available to these individuals as long as they dont have any other coverage.
PROGRAMS THAT OFFER FREE PRESCRIPTION DRUGS/INCOME BASED
Eligibility for all programs listed below:
Medicare enrollment;
No other form of prescription coverage, and
Within the income guidelines shown.
Pfizer Connection to Care= free Pfizer medications
$1,333 per month single $2,083 for a couple
Takeda Pharmaceutical America- Actos ($97 a month)
$2,245 per month single $3,636 couple
Glaxco Smith Kline Bridges to Access
$1,871 per month single $2,525 couple
Wyeth Ayerst
$1,497 per month single $2,020 couple
Merck
$1,500 per month single $2,000 couple $2,917 family of four
Forest Pharmaceuticals, Novartis, Bristol Myers Squibb and most other pharmaceutical companies have patients assistance programs. The programs listed above are the only ones whose income guidelines are published.
There are no better deals for Medicare beneficiaries who qualify for these programs.
PROGRAMS THAT OFFER PRESCRIPTION DRUGS FOR A LOW CO-PAY/Income Based
Aged and Disabled Federal Poverty Level Program= Medi-Cal No Share of Cost
$979 per month single $1382 for a couple
$2000 assets $3000 assets $5 co-pay
Lily Answers- $12 co-pay
$1500 per month single $2,000 couple
Pfizer Share Card- $15 co-pay
$1500 per month single $2,000 couple
Novartis Care Card $12 co-pay
$1500 per month single $2,000 couple
Medicare Transitional Assistance Program 10% co-pay $600 pre-loaded benefit card
$749-$1009.99 single $1010-$1363.99 couple
Medicare Special Transitional Program 5% co-pay $600 pre-loaded benefit card
Less than $748 single Less than $1010 couple
PROGRAMS THAT OFFER FREE DISCOUNT CARDS WITH SUBSTANTIAL SAVINGS
Orange Card- Glaxco Smith Kline advertises 30%-40% discount
$2,500 per month single $3,330 couple
Together Rx Card- several companies 20%-40% savings
$2,333 per month single $3,167 couple
PROGRAMS THAT OFFER DISCOUNT CARDS/ FEE
Your Rx www.yourrxplan.com
No income limit
$25 annual fee for single $40 annual fee for family
Peoples Prescription Plan www.drugstore.com
No income limits
$7.95 per month
New Medicare Approved Discount Cards
Annual fee- up to $30
Savings: 10%-15%
Region65 and over in HouseholdsMedicare + SupplementMedicare + Medi-CalMedicare only65 and over who do not have Rx coverage **Sierra
30,33123,4153,0333,883
11,844Far Northern /Shasta14,529/
23,80310,025/
15,8762,978/
4,3321,526
3,5955,255/
9,548
Total-14,803North Central44,47531,7107,6945,07116,677North Coast40,69227,7929,2373,66313,418North Eastern19,82116,0351,90318006,306UCLA Center for Health Policy Research Source: Census 2000
** This includes those with Medicare supplemental and those with Medicare only.
Sierra region includes Alpine, Amador, Calaveras, Inyo, Mono, Mariposa and Tuolumne counties.
Far Northern region includes Shasta, Lassen, Modoc, Siskiyou and Trinity counties.
North Central includes Butte, Colusa, Glenn, Tehama counties.
North Coast includes Del Norte, Humboldt, Mendocino and Lake counties.
North Eastern region includes Sierra, Nevada and Plumas counties.
All highlighted counties have Medicare HMOs available.
Rural Issues:
Access to information.
Access to retail/discount pharmacies.
Resources needed to reach this population.
35% have no prescription coverage. This is the population who will be eligible for the Medicare Prescription Discount Cards and the TAP/STAP.
Southern Rural Counties
Region65 and over in HouseholdsMedicare + SupplementMedicare + Medi-CalMedicare only65 and over who do not have Rx coverage **Kings and Tulare43,00025,02612,642533212,615Kern59,85335,55318,9735,3278,882San Bernardino140,41098,56725,5559,54817,729UCLA Center for Health Policy Research Source: Census 2000
All highlighted counties have Medicare HMOs available.
16% have no prescription coverage.
Drug SBS393CostcoPharmaceutical
Discount Card Pharmaceutical
Patients
Assistance
ProgramsMedicare Approved Discount CardsCanadian
PricesActos 15mg97.11 (30)97.27None300%FPL
$26,940/$36,360@$87189.00 (90)Accupril
10mg37.68
(30)36.39Pfizer Share $15Pfizer
$16,000/$24,000@3473.61 (90)Advair 100/50114.36
(30)108.57TogetherRx
@$95Bridges to Access GSK
$22,450/$30,300@10582.47 (60)Ambien 10mg86.58
(30)81.37NoneNone@79Not availableCelebrex
100mg101.35
(30)85.27Pfizer Share $15Pfizer
$16,000/$24,000@9271.62 (100)Celexa 40mg150.63
(30)118.89Forest@13545.08 (30)Coumadin
5mg26.46
(30)25.39TogetherRx
@$21BristolMyersSquibb@2339.87 (100)Diovan HCT 80/12.551.99
(30)53.09TogetherRx
@$45Novartis@4834.28
(30)
Effexor 150mg99.57
(30)90.77NoneWyeth
$17,960/$24,240@89167.34 (100)Fosamax 70mg69.68
(4)62.97NoneMerck
$18,000/$24,000@6349.62
(4)Lanoxin 250mg8.84
(30)6.79TogetherRx
@$7Bridges to Access GSK
$22,450/$30,300@853.54 (250)Neurontin 100mg18.71
(30)18.29Pfizer Share $15Pfizer
$16,000/$24,000@1639.78 (100)Lipitor 10 mg70.43
(30)66.67Pfizer Share $15Pfizer
$16,000/$24,000@63144.59 (90)
Sources:
HYPERLINK "http://www.medi-cal.ca.gov/sb393inq" www.medi-cal.ca.gov/sb393inq
HYPERLINK "http://www.costco.com" www.costco.com
HYPERLINK "http://www.needymeds.com" www.needymeds.com
HYPERLINK "http://www.pfizersharecard.com" www.pfizersharecard.com
HYPERLINK "http://www.together-rx.com" www.together-rx.com
HYPERLINK "http://www.canadiandrugstore.com" www.canadiandrugstore.com
Size of Family Unit
48 Contiguous States and D.C.
Alaska
Hawaii
1
$ 8,980
$11,210
$10,330
2
12,120
15,140
13,940
3
15,260
19,070
17,550
4
18,400
23,000
21,160
5
21,540
26,930
24,770
6
24,680
30,860
28,380
7
27,820
34,790
31,990
8
30,960
38,720
35,600
For each additional person, add
3,140
3,930
3,610
SOURCE: HYPERLINK "http://aspe.os.dhhs.gov/poverty/03poverty.htm" Federal Register, Vol. 68, No. 26, February 7, 2003, pp. 6456-6458. Last updated: March 1, 2003
Side by Side Comparison of Pharmaceutical Patients Assistance Programs and Medicare
Pfizer Connection to Care GlaxcoSmithKline Brigdes to AccessMerckLily AnswersMedicare TAPMedicare STAPFee000000Co-pay0$50$1210%5%Monthly income
Limit$1333/
$2083$1871/
$2525$1500/
$2000$1500/
$2000 Under
$1010/
$1364$748/
$1010Additional benefit0000$600$600
Pfizer ShareNovartis CareTogether Rx CardYour RxMedicare approved cardsFee000$25-$40Up to $30Co-pay$15$12--Income limit$1500/
$2000$1500/
$2000$2333/
$3167-Over
$1010/
$1364Advertised savings20%-40%Varies 10%-15%Side by Side Comparison Discount Cards
Case Analysis
CASE #1
Medicare beneficiary/ no other prescription coverage/ income $958/assets $3000
California
Discount
Prescription
Program
(SB 393)CostcoPharmaceutical
Patients
Assistance
Program Discount cardMedi-Cal
A&D
FPL
ProgramMedicare
Prescription
Transitional
Assistance
Program Lipitor$70.43$66.67Qualifies
No costQualifies-
$15 co-payNot qualified
Assets10% co-pay
$7 Actos$97.11$97.21Qualifies
No costNone 10% co-pay
$9.71Fosamax$69.68$62.97Qualifies
No costNone 10% co-pay
$6.96TOTAL
Rx Cost $237.22$226.85 0$15$237.22$23.67 Source: HICAP Case file: Senior Advocacy Center of Northern Californi
The Medicare Transitional Assistance Program offers a $600 pre-loaded benefit card. This card will last 2.8 months for this beneficiary. Having the card would disqualify the beneficiary from the Pharmaceutical Patients Assistance Programs.
CASE #2
Couple/no other Rx coverage/income $2000/assets $5000
CostcoPharmaceutical
Patients
Assistance
Program Discount cardMedi-Cal
A&D
FPL
ProgramMedicare
Prescription
Discount
CardsNeurontin
$18.29Qualifies
No cost
(Pfizer)Pfizer Share
$15 co-payNot qualified@ $16.83-$15.91Advair
$108.57Qualifies
$5 co-pay
(GlaxcoSmithKline)TogetherRx
@ $95 @ $97.21-$102.96Diovan HCT
$53.09Qualifies
$12 co-pay
(Novartis)TogetherRx
@ $45 @ $45.05-$47Celebrex
$85.27Qualifies
No cost
(Pfizer)Pfizer Share
$15 co-pay @ $86.15-$91.22Lanoxin
$6.79Qualifies
$5 co-pay
(GlaxcoSmithKline)Together Rx
@ $7 @ $7.51-$7.96Total
$272.01$17$177 @ $252.75-$265.05
Source: HICAP Case file: Senior Advocacy Center of Northern California
CASE #3 Couple/no other Rx coverage/income $1000/assets $5000
California Discount Prescription Program
(SB 393)CostcoPharmaceutical PAPDiscount cardMedi-Cal
Aged and Disabled FPL ProgramMedicare Prescription
Special Transitional Assistance ProgramSinemetNo price available$85.97BristolMyersSquibb
Income guidelines unpublished-apply TogetherRx
@ $68Not qualified@ $4.30Paxil$82.35$82.47GlaxcoSmithKline
Qualified $5 co-payTogetherRx
@ $68Not qualified@ $4.12MirapexNo price available$40.59Pharmacia- qualified $5 co-payPfizer Share $15 co-payNot qualified@ $2Effexor$99.57$90.77Wyeth-qualified
-No costNoneNot qualified@ 4.53Total$181.92+$299.80$10$151$14.95Source: HICAP Case file: Senior Advocacy Center of Northern California
The Medicare Special Transitional Assistance Program $600 pre-loaded card will last for 2 months. Having this card will disqualify the beneficiary from Pharmaceutical Patients Assistance programs.
PAGE 1
Californias Poorest Counties
Population Age 65 and Over with Income Below 200% of the Federal Poverty Level
Californias Most Rural Counties
Southern Rural Counties
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