ElderWeb

Indiana Governor Mitch Daniels announced the launch of a new Web site to help Indiana residents find discounted or no-cost prescription drugs. The Web site asks users for age, income and insurance information to determine their eligibility for low-cost drugs. Patients and doctors can enroll in discount programs through the Web site or by calling a toll-free number. Daniels said that he opposes programs that help residents purchase medications from abroad, saying that he didn't want to take the chance that anyone is hurt by counterfeit or expired medications.

The Las Vegas Sun reports that Daniels is a former executive with Eli Lilly and Co., and the web site indicates that it a collaborative effort of a group of pharmaceutical companies and health organizations.

The site is located at http://rxforindiana.org/.

A new plan to help low-income elderly in Massachusetts with the cost of prescription drugs started in April of this year. This plan covers all premiums and deductibles for people age 65 or older who are at or below 188% of the Federal Poverty Level (FPL). People between 188% and 200% of the FPL are eligible for coverage, but will pay premiums and deductibles, based on their income.

The Chicago Tribune reports that Illinois Department of Revenue (IDR) officials have programmed a special toll-free tax hot line for seniors and the disabled, 1-800-624-2459, so that no one can get through to ask questions more than three times a week. The line is used by people who have questions about the complex circuit-breaker program which provides property tax relief and prescription drug discounts for the elderly and disabled. The Tribune reports that officials of the Department of Revenue said they made the decision to ration calls because the agency lacks resources to adequately staff the hot line. The agency first implemented call rationing in 1998 to limit inquiries from people who bombard the hot line several times a day just to ask where their checks are, and noted that one man from Peoria called the hot line 1,520 times in 45 days. According to the Tribune story, the hot line logged nearly 1.3 million attempts to access it in March, but only 26,317 of those calls were routed to live operators. 62,150 calls went into an automated system that gives answers to frequently asked questions, and more than 90% of incoming calls to the hot line got a busy signal. Officials are also trying to encourage people to use their Web site to reduce the call levels.

The Florida Agency for Health Care Administration announced that they have published a new guidebook online, called Understanding Prescription Drug Costs. The guide contains information for everyone who needs prescription drugs - whether or not they have health insurance to cover those costs. The purpose of this brochure is to help consumers know what cost-saving options there are and what questions to ask. They point out that the best sources of information to help save money on prescription drugs are physicians, pharmacists, and the customer service or employee benefits office of your health insurance plan. The brochure is a new addition to the extensive information about drugs available on FloridaHealthStat.com, the official source of consumer healthcare information from Florida government health and human service agencies.

New York enacted legislation which significantly enhanced the Elderly Pharmaceutical Insurance Coverage (EPIC) Program. The program is now available to people age 65 or older with an annual income of $35,000 or less if single, or $50,000 or less if married. The lowest income seniors pay an annual fee of between $8 and $300 dollars to receive medications. Higher income seniors pay an annual deductible of between $517 and $1,715, depending on their income.

Indiana has implemented a new program to help people over age 65 without drug insurance to pay for the cost of prescription medicines. The new program, called HoosierRx, began in September, and is available to people with incomes below $940 a month for single people and $1,266 a month for married couples. Those who qualify can receive refund certificates every three months, starting January 2001. The refunds will cover up to half of those seniors' prescription costs in each quarter, up to $1,000 a year. The program is funded by Indiana's portion of the tobacco settlement.

Despite pharmaceutical industry opposition, the US Health Care Financing Administration (HCFA) approved an extension of an existing Medicaid demonstration in the state, allowing a proposed drug discount program to be implemented this January, making Vermont the only state in the nation with a pharmaceutical program as part of Medicare, according to Peter Van Vranken, a health policy analyst for Vermont Governor Howard Dean.

Under the Vermont Health Access Plan (VHAP), some 37,550 Medicare beneficiaries will be eligible to buy prescription drugs at discounted prices through the state's Medicaid program. The expanded program also includes 31,350 individuals who are under 300% of the federal poverty level. Individuals who pay a $24 annual enrollment fee will receive a card entitling them to receive a discount on drug purchases at the pharmacy.

State officials estimate that participants eventually will be able to purchase drugs at savings of about 30%. In a letter to HCFA, the Pharmaceutical Research and Manufacturers of America (PhRMA) challenged Vermont's program on grounds that it would run afoul of Medicaid law. However, the Congressional Research Service later determined that HCFA could grant a waiver without violating Medicaid law.

The Maine Bureau of Elder and Adult Services (BEAS) conducted a survey of drug prices in Maine pharmacies, and have made the results of that survey available on the Internet. In addition, they have created an online "Drug Pricing Calculator" which allows consumers to indicate specific combinations of drugs they may need, and the area of the state where they are located. The tool shows the total cost of the drug combinations they selected from each pharmacy in their area.

The governors of New Hampshire, Vermont, and Maine announced that they have created a multi-state pool for the purchase of prescription drugs. The purchasing pool will include the Medicaid populations from all three states, about 330,000 people. By working together to focus on quality and management efficiency, the three states hope to save an estimated 10% to 15% on their prescription drug programs. The benefits of the combined purchasing pool will be available on a voluntary basis to other groups, including uninsured individuals, and businesses. They released a request for proposals, seeking bids from pharmacy benefits management companies to operate the purchasing pool.

Registration has begun for SILVERxCARD, South Carolina's new $20 million prescription drug plan for the state's poorest elderly. The SilverCard initiative will cut medication costs for the poor who are at least 65, have lived in the state for at least six months, and have no other prescription drug insurance.

Applications will be accepted until December 1. Seniors can call toll- free at (877) 239-5277 to have an enrollment form sent to their home. Local pharmacies, Councils on Aging, doctor's offices, libraries and legislative offices also will distribute applications. Those who qualify will be able to start using their SilverCard at participating pharmacies Jan. 1. Co-payments and deductibles will be determined in December but are expected to be modest.

Priority will be given to single seniors making $12,525 or less, and to married couples earning a combined $16,875 or less. But single seniors who earn $14,612 or less, and married couples earning $19,678 or less, also are encouraged to apply. Persons whose income is below SILVERxCARD limits but who have been rejected Medicaid coverage by the DSS due to assets may apply for SILVERxCARD and include with their application a copy of their rejection letter from DSS -AS LONG AS that rejection letter is dated within the past SIX MONTHS.

Louisiana's Treasurer says state government could save as much as $90 million a year by negotiating lower prescription-drug prices for the poor and elderly. He said the state could pool its prescription-drug needs and demand the kind of drug discounts enjoyed by federal agencies, and that this approach might save between $30 million and $90 million in drug costs in the Medicaid health-care program for the poor funded in part by the state.

But Secretary of Health and Hospitals David Hood said the state considered making bulk drug purchases for Medicaid a few years ago but it wasn't cost-effective. Hood said Louisiana gets about $85 million a year in rebates from drug makers for medicines dispensed to Medicaid recipients and that the state would lose those rebates if it pursued Kennedy's idea, and that would wipe out other savings.

The president-elect of the Louisiana Pharmacists Association, Allen Cassidy, said his organization probably would support Kennedy's idea as long as patients could buy medicines at regular drug stores, but his group wouldn't want to see a mail-order program. One problem with Kennedy's idea is that many pharmacies, including many of the larger chains, don't purchase drugs directly from manufacturers. They buy drugs from wholesalers, so it's not clear how discounts would filter from manufacturers to retail purchasers.

Kennedy said he doesn't know the details of how his proposal would work, but he is confident some savings would trickle down. The treasurer said similar efforts are under way in at least 10 states.

Kennedy said Louisiana has seen a tremendous increase in what it pays for prescription drugs through the Medicaid health-care program for the poor. The total has gone from $80 million in 1989 to $370 million this year, he said. If costs continue to increase at the same rate, costs could hit $800 million a year within the next five years.

State Senators Chris Cummiskey (D-Phoenix) and Tom Freestone (R-Mesa) asked Governor Jane Hull to call the Legislature into special session to address the crisis of skyrocketing prescription drug prices faced by many of Arizona's seniors. This crisis is expected to worsen on January 1, 2001 when four more HMOs leave the Medicare HMO market in rural Arizona, taking much needed prescription drug coverage with them. It is estimated that upwards of 200,000 Arizona seniors will be left without coverage by the end of the year.

Cummiskey and Freestone have proposed a two-stage plan to make prescription drugs more accessible for Arizona?s seniors. The first stage involves creating prescription purchasing coalitions that will benefit all seniors, regardless of income. The free market styled purchasing coalitions will take advantage of group purchasing to negotiate bulk rates using the same benefit management companies that negotiate lower rates for HMOs.

The second stage provides direct support to the neediest seniors through direct subsidies. Seniors with incomes below the federal poverty level, about $8,300 for an unmarried senior, would receive a 100% subsidy for the price of their prescriptions. Additional relief will be provided for seniors with incomes up to 250% of the federal poverty level, almost $20,900 for an unmarried senior, through subsidies ranging from 25% to 75% of the cost of prescription medication depending on the person?s income.

Both parts of the plan have won wide support from such groups as the American Association of Retired Persons (AARP) and the Arizona Silver Haired Legislature.

Illinois has expanded the Senior Pharmaceutical Assistance Program by increasing the income level for eligibility to $21,218 (1 person household), $28,480 (2 person household) or $35,740 (3+ person household) from the previous $16,000 limitation which applied to households of all sizes. The annual fee was reduced to $5 for persons below the poverty line and $25 for all other persons from the previous fees of $40 and $80, and co-payments were reduced to nothing for persons below the poverty line and $3 for all others from the previous levels of $15 and $25. The maximum benefit was also increased from $800 a year to $2,000 a year. These changes were effective starting July 1, 2000, and the old limitations will apply to drugs purchased prior to that date. The new income levels will also apply to Circuit Breaker property tax relief.

The Pharmaceutical Research and Manufacturers of America (PhRMA) has sued the state of Maine, challenging the state's prescription drug-pricing law as unconstitutional and an abuse of fair trade practices. PhRMA filed the suit in US District Court in Maine seeking a preliminary injunction to prevent Maine officials from implementing the law until the court has ruled on the matter.

The Maine Rx program enables the state to extract rebates and discounts from drugmakers on behalf of residents who have no prescription drug benefits, by acting as the benefits manager, negotiating rebates and pharmacy discounts that will be used to lower drug prices.

Individual drug manufacturers are taking their own steps. SmithKline Beecham decided to "reconfigure" its relationship with drug wholesalers that service Maine drug retailers, by using wholesalers not based within the state, because the Maine prescription drug law is "vague and difficult to interpret."

Medicare recipients can now use any California pharmacy that accepts Medi-Cal and receive prescriptions at the Medi-Cal rate plus a 15 cent processing fee for each prescription, in a new program that went into effect on February 1, 2000. Senate Bill 393 enables Medicare recipients to obtain their prescription drugs at a cost no higher than Medi-Cal rates.

When a Medicare beneficiary has a prescription filled, he or she should present the pharmacy staff with the Medicare card. If the doctor phones the prescription in, ask the doctor to notify the pharmacy that the patient is a Medicare recipient. Beneficiaries should ask their regular pharmacies to put a note on their record stating that they are a Medicare recipient so that they will be charged the Medi-Cal rate for future prescriptions.

The Center For Policy Alternatives (CPA) issued a policy brief, "Playing Fair: State Action to Lower Prescription Drug Prices" and announced a 21-state alliance to attack the problem of spiraling prescription drug prices. They stated that, with prescription drug legislation stalled in Congress, there is significant momentum across the states to support the Prescription Drug Fair Pricing Act. This act is modeled after the bill passed in Maine in May, 2000 with near unanimous, bipartisan support. This act allows states to use their power to negotiate steep discounts by pooling all uninsured residents.

The states which have joined this alliance are Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Hawaii, Iowa, Illinois, Maryland, Michigan, Minnesota, Missouri, North Carolina, New York, Pennsylvania, South Carolina, Texas, Vermont, Washington, and Wisconsin. CPA a nonpartisan public policy and leadership development center.

Both the Florida House and Senate have unanimously passed S940-The Prescription Affordability Act for Seniors, a bill to provide pharmaceutical assistance to the elderly in Florida. The act is a catastrophic pharmaceutical expense assistance program for people who qualify for limited assistance under the Florida Medicaid program as a result of being dually eligible for both Medicare and Medicaid, but whose limited assistance or Medicare coverage does not include any pharmacy benefit. Specifically eligible are low-income senior citizens who are Florida residents age 65 and over, who have an income between 90% and 120% of the federal poverty level, who are eligible for both Medicare and Medicaid, who are not enrolled in a Medicare health maintenance organization that provides a pharmacy benefit, and who request to be enrolled in the program.

As a condition of participation in the Florida Medicaid Program or the pharmaceutical expense assistance program, a pharmacy must agree to charge any individual who is a Medicare beneficiary and who is a Florida resident showing a Medicare card when they present a prescription a price no greater than the cost of ingredients equal to the average wholesale price minus 9%, and a dispensing fee of $4.50.

The program will be administered by the Agency for Health Care Administration (AHCA) in consultation with the Department of Elderly Affairs (DOEA).

The National Conference of State Legislatures has announced that sixteen states are currently operating programs which provide older people with assistance in covering the high cost of prescription drugs. For example, in February California initiated a discount drug program for Medicare recipients, irregardless of their income, which is expected to impact about 1.3 million people. Massachusetts initiated a new pharmacy assistance program on January 1 of this year which is available to single people age 65 and over with incomes under $41,220 and couples with incomes under $55,320. The NCSL web site contains a summary of the programs currently in place, and several others which are under consideration.