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Home -> A Guide to Prescription Drug Assistance in Maine
A Guide to Prescription Drug Assistance in Maine - March 2007Download an Adobe PDF version of the Guide.
IntroductionMany seniors and younger adults with disabilities need prescription medication to stay healthy. However, the high cost of these helpful life-saving drugs makes it hard for people, especially those with limited or fixed incomes, to afford them. This booklet is a guide for older people and adults with disabilities who need help paying for prescription drugs. In addition to information about programs in Maine, other resources such as consumer buying tips and where to get help in your community are included. If you have questions about paying for prescription drugs or other health care issues, you can get help from the State Health Insurance Assistance Program (SHIP). This statewide service provides information and assistance with Medicare, supplemental insurance (Medigap), Medicare Prescription Drug Coverage, Medicare Savings Programs, MaineCare and other kinds of health insurance issues. These trained staff will also help with application forms and guide you through the process. You can talk to a SHIP counselor over the phone, at the office, or in your own home. No fees are charged and all information is kept private. An interpreter will be provided if you need one. To get in touch with a SHIP counselor, call your local Area Agency on Aging at 1-877-353-3771 or the Legal Services for the Elderly Helpline at 1-800-750-5353 (Voice and TTY). The Office of Elder Services promotes the highest level of independence for people who are older and adults with disabilities. If you don't find what you need in this guide, call us at 1-800-262-2232 (TTY 1-800-606-0215) for assistance. Section 1 - Programs and BenefitsMedicareDoes Medicare Cover Prescription Drugs?Medicare is a health insurance program for people age 65 and older, some people with disabilities under age 65 and people with permanent kidney failure. Medicare Part A (hospital insurance) pays for prescription drugs while you are in the hospital. Medicare Part B (medical insurance) pays for prescription drugs in very specific situations. If you have questions about Medicare Part A and Part B benefits, contact your local area agency on aging or Legal Services for the Elderly. Medicare Prescription Drug Coverage Medicare Part D, provides outpatient prescription drug benefits. The Medicare Modernization Act of 2003 added outpatient Prescription Drug Coverage effective January 2006. This benefit is voluntary and available to everyone with Medicare. To get Medicare Part D prescription coverage, you must choose and enroll in a Medicare Prescription Drug Plan offered in Maine. Insurance companies and other private companies work with Medicare to offer these plans. Who Can Join? Anyone with Medicare Part A and/or Part B can join a Medicare Prescription Drug Plan. When Can I Join? You can join when you first get Medicare and during the annual enrollment period, between November 15 th and December 31 st each year. You may also be eligible for enrollment at other times. During the annual enrollment period you can join a plan for the following year or keep the plan you already have. Joining a plan is voluntary but if you don’t join when you are first eligible, you may pay higher monthly premiums unless you already have a drug plan that covers at least as much as a Medicare Prescription Drug Plan. How Much Does It Cost? How much you will pay depends on the plan that you choose. The monthly premium is set by the company offering the plan. Plans can also charge a yearly deductible. You will also pay a part of the cost of each prescription, called the co-payment or coinsurance. Depending on your drug costs, you may reach a coverage gap and/or the catastrophic benefit. Is There Help For People With Limited-income And Resources? Yes. If you have limited income and resources (like savings accounts), you may qualify for help with the cost of the monthly premiums, annual deductibles and other out-of-pocket expenses. If you have MaineCare (including Medicare Savings Programs) you will be automatically eligible for the extra help. You will not have a monthly premium or annual deductible, and you will not have a coverage gap. What If I Have MaineCare Or Low Cost Drugs For The Elderly And Disabled Program ( DEL)? Medicare will provide most of your drug coverage. MaineCare will continue to pay for prescription drugs that are not part of Medicare’s coverage (excluded drugs). The Low Cost Drugs for the Elderly and Disabled Program may provide Wrap Benefits and help reduce some of your Medicare Part D costs. Where Can I Get More Information? The information above is a very brief overview of the Medicare Prescription Drug Coverage. Following is a list of agencies that can give you more information and help answer your questions:
www.socialsecurity.gov What are Medicare Advantage Plans? Medicare Advantage Plans are health plan options that are approved by Medicare and run by private companies. Some Medicare Advantage plans have prescription drug benefits. There are different types of Medicare Advantage plans and it is important to learn how they work and what they offer before you decide to join. Here are a few facts about joining a Medicare Advantage plan:
Check with your local Area Agency on Aging or Legal Services for the Elderly to see if this is an available option in your area. What About Medicare Supplemental Insurance?Medicare supplemental insurance policies (also called Medigap plans) that covers some of the costs of prescription drugs are no longer sold or issued. MAINECARE (Medicaid)How Do I Find Out If I Am Eligible for MaineCare?MaineCare (Medicaid) helps eligible low-income persons with their medical costs. If you are eligible for MaineCare, your prescription drugs will be covered except for a small co-payment that you pay the pharmacy for each prescription. People with both MaineCare and Medicare need to enroll in a Medicare Prescription Drug Plan to get most of their prescription drug coverage. Income limits change each year. The asset limit for an individual is $2,000**; for a couple the limit is $3,000**. ** MaineCare excludes up to $8,000 of savings for an individual and $12,000 for a household of 2 or more, and a 2nd vehicle in certain situations. To apply, call or visit your local Department of Health and Human Services Regional Office. Your local Area Agency on Aging has MaineCare applications and can help you fill one out. If your income and assets are slightly over the limits, it is still a good idea to fill out an application. Even if you are not eligible for full MaineCare benefits, you may be eligible for other types of MaineCare assistance: Medicare Savings ProgramsIf you have Medicare you may be eligible for MaineCare to pay your Medicare Part B premium, deductibles and coinsurance. For more information call your local Area Agency on Aging at 1-877-353-3771 or Legal Services for the Elderly at 1-800-750-5353 (Voice and TTY). MaineCare for Children (Cub Care )Children can receive the medical services they need through MaineCare. Covered services include regular check-ups and immunizations, school and sports physicals, prescription drugs, dental care, vision and hearing testing, hospital visits and more. The cost of MaineCare is based on family size and income. There is no cost for some families. Other families will pay a monthly premium ranging from $5 - $30. Health Insurance for the Working DisabledMaineCare has a program that allows people with disabilities to work and have MaineCare benefits. Depending on income, there may be a monthly premium of no more than $20 per month. For more information, call your local Department of Health and Human Services office. The Eligibility Specialist at the Department of Health and Human Services will help you get any assistance for which you are eligible. You can also call your local Area Agency on Aging or Legal Services for the Elderly to find out more about MaineCare eligibility. Low Cost Drugs for the Elderly and DisabledThe Low Cost Drug Benefit (DEL) is funded by an appropriation from the State general fund. The program is not federally funded. To provide this program, the state works with drug manufacturers that agree to participate in the rebate program. Coverage of drugs is limited to drugs on the DEL Preferred Drug List (PDL). This is the list of drugs for which the manufacturer has signed rebate agreements with the State. Eligibility:
Basic Benefit:
Supplemental Benefit: The Supplemental benefit includes other drugs not covered in the Basic Benefit. The drugs must be medically necessary and supplied from participating manufacturers. Actual savings vary from drug to drug. DEL Members pay the State’s negotiated MaineCare rate minus $2.00. Catastrophic Spending Limit: After a Member spends $1,000 on eligible prescription drugs, the State pays 80% of the cost of all eligible prescription drugs, regardless of any disease or condition. The drugs must be medically necessary and supplied from companies with agreements with the State. Eligible prescription drugs are only those drugs that were covered by DEL on May 31, 2001. The Catastrophic Spending Limit is tracked from August 1 st each year to July 31 st of the following year. Note:
Maine Rx PlusWho is eligible for the Maine Rx Plus program? You are eligible for the Maine Rx Plus program if you live in Maine and meet the income guidelines. There are no age or asset criteria. What are the income guidelines? You may also be eligible if your out-of-pocket expenses are more than 5% of your household income; or if your out-of-pocket medical expenses are more than 15% of your household income. What is the benefit of the Maine Rx Plus Program? The benefit is a discount on all drugs listed on the MaineCare Preferred Drug List. You cannot get a discount on any drugs that are not on this list. How much will I save? You may get discounts of 15% to 60% off the retail prices. The greatest discounts are for generic drugs. Where do I apply? Who can I call for help with the application? Apply at the Department of Health and Human Services office nearest you. The Eligibility Specialists at DHHS will help you. You can also get an application and help to fill it out from your local area agency on aging. DIRIGOCHOICEDirigoChoice is health care coverage for Maine businesses with 50 or fewer employees, the self-employed, and individuals. Enrollees receive discounts on monthly payments and reductions in deductibles and out-of-pocket expenses based on their income and family size. Discounts can be as high as 100%. Anthem Blue Cross and Blue Shield of Maine and its network of appointed insurance producers/agents sell DirigoChoice to small businesses and self-employed individuals. Coverage Information: 1-800-409-7520 (TTY1-888-671-4333) Application for Coverage:
COMMUNITY HEALTH CENTERSCommunity health centers provide medical services to people on a sliding fee scale. Locations and telephone numbers. The clinics do not have their own prescription drug program, but they may be able to give you samples of the medication. Most clinics will help you enroll in the patient assistance programs of the drug companies. Drug Company Patient Assistance ProgramsMany drug companies have special programs to help people who cannot afford the cost of their brand name prescription drugs. If it is hard for you to pay for your drugs, ask your doctor for help to get your drugs directly from the drug companies. These programs vary and many companies do not cover generic drugs. Who is eligible?Anyone can apply for this program; you do not have to be older or disabled. Each company has its own requirements. Most companies require that:
How do I apply?The application process for each company is different. Usually your doctor completes and sends in the application form. How will I get my medications?The drug company will send a supply of the medication to your doctor. Usually it will be a 90-day supply. You will have to pick up the medication at your doctor's office. How long will I be able to get help?Most companies do not have time limits and will continue to send you the medications as long as you are eligible for the program. You will need to check with the companies to find out if they have time limits. Who do I contact for more information?MedHelp Maine is a non-profit organization established to develop community-based prescription assistance programs managed by hospitals or other organizations. If you are looking for information and help to apply for Patient Assistance Programs, ask your doctor or other health care provider to call MedHelp Maine : 1-888-283-9883 (toll-free) or www.medhelpmaine.org. Program locations are listed in Section 2 of this booklet. If you have Medicare and are enrolled in a Medicare Prescription Drug Plan or Medicare Advantage Plan, there are special rules about participating in Patient Assistance Programs. You can learn more from Medicare at 1-800-MEDICARE (1-800-633-4227) or www.medicare.gov. Talk to your doctor or contact your local Area Agency on Aging for more information about these programs. Free ClinicsFree clinics offer free primary care services to people with a low income or who have no insurance or are under-insured. Each clinic has its own eligibility guidelines and may provide prescription medications. Some clinics do not offer services to people who have Medicare. Call the clinics to find out what services are available and if you are eligible. The three largest clinics are: Biddeford Free Clinic Ellsworth Free Clinic Portland Street Clinic HIV/AIDS DRUG ASSISTANCE PROGRAM (ADAP)Maine residents with HIV/AIDS can get assistance from the State of Maine to get HIV-related medications free of charge. ADAP is a program of the Maine Center for Disease Control and Prevention (Maine CDC), HIV/STD Division. To be eligible a person must have a household income of 400% or less of the federal poverty level and meet certain medical requirements. People with HIV/AIDS who are not able to get all their medications through ADAP should apply directly to the drug companies for their patient assistance programs. If you are interested in ADAP contact the Maine CDC at (207) 287-2899. You can also contact one of the HIV/AIDS organizations in the state or contact the AIDS Hotline at 1-800-851-2437. HOSPITAL PROGRAMSMost hospitals have assistance programs for people who have a low income and no health insurance. Services will either be free or have a copayment under a sliding fee scale. If you need help paying for hospital services or outpatient care, ask if you can fill out an application. You may still have to pay for some services, which are not covered under the program. If medications are prescribed that you cannot afford, these programs will give you samples, when available, and help you enroll in the patient assistance programs of the drug companies. CarePartnersCarePartners is a network of volunteer physicians, hospitals, and other providers (located in the Greater Kennebec County area, Lincoln County and the Greater Portland area) who agree to provide services to CarePartners enrollees for little or no cost. For more information or to enroll in the CarePartners Program call: 1-877-883-1797. INDIAN HEALTH SERVICESA wide range of medical, dental, mental health and social services are available to the Penobscot, Passamaquoddy, Maliseet and Micmac peoples. Each group has a clinic where most primary health care services are available. Prescription drugs can also be covered under Indian Health Services programs. However, there are limits to both the medical services and prescription drug coverage. For more information about Indian Health Services in Maine, call the health center for the tribe to which you belong. Military Retiree BenefitsTRICARE Senior Pharmacy ProgramMilitary retirees, spouses and some former spouses or survivors are eligible for two programs provided by the Department of Defense. TRICARE for Life and the TRICARE Senior Pharmacy Program are open to individuals age 65 and older. TRICARE for Life will pay after Medicare and pays for Medicare deductibles, copayments and some remaining medical costs. The Senior Pharmacy Program pays prescription drug benefits for this population. There is no premium charged for this program, but beneficiaries are required to pay varying amounts of deductibles or copayments, depending on where they obtain their medications and whether or not they are generic or brand name. To be eligible for the Senior Pharmacy Program, you must be a retiree, dependent or survivor who is Medicare eligible. If you turned 65 before April 1, 2001, you are eligible to use the retail and mail order pharmacy benefit without being enrolled in Medicare Part B. If you turned 65 on or after April 1, 2001, you will need to be enrolled in Medicare Part B in order to use the pharmacy benefit. For more information and complete eligibility requirements for the TRICARE for Life and TRICARE Senior Pharmacy Program, contact Sierra Military Health Services (the Northeast Regional Contractor) toll free at 1-888-999-5195. Veterans BenefitsOutpatient pharmacy services are provided free to: (1) veterans receiving medication for treatment of service-connected conditions; (2) veterans rated with 50% or more service-connected disability: and (3) veterans whose annual income does not exceed the maximum VA pension. If you are a veteran, call the Veterans Administration (207-623-8411 ext. 5300). You can also get more information from veterans groups such as the AMVETS, VFW or the American Legion. Nonservice-connected veterans and veterans with a service-connection rated less than 50% receiving medications on an outpatient basis from VA facilities for the treatment of nonservice-connected ailments are charged $8 for each 30-day supply. CHAMPVA for LifeCHAMPVA for Life (CFL) is a healthcare benefits program for people over the age of 65 who are dependents of veterans, survivors of veterans or survivors of persons who died in the line of duty. CFL covers most healthcare services and supplies that are medically and psychologically necessary. To be eligible for CFL you cannot be eligible for TRICARE/CHAMPUS. CFL provides an outpatient prescription drug benefit. If you have other insurance that has an outpatient prescription benefit, select any pharmacy and pay for your prescription. CFL will typically pay the co-pay. If you do not have insurance with an outpatient prescription benefit you have two options:
For more information and complete eligibility requirements for CFL, contact them at 1-800-733-8387 or hac.inq@med.va.gov (e-mail). Section 2 - Agency ContactsArea Agencies on AgingAroostook Agency on Aging Eastern Agency on Aging Senior Spectrum SeniorsPlus (Cumberland and York Counties) 136 U.S. Route 1 Scarborough, ME 04047 1-800-427-7411 Local - 207-396-6500 TTY - 207-883-0532 Office Hours: 8:00 am - 4:30 pm, Monday - Friday All Area Agencies on Aging can be reached by calling this toll free number: 1-877-ELDERS1 (1-877-353-3771) Office of Elder Services442 Civic Center Drive Community Action ProgramsSome Community Action Programs have staff and volunteers who are trained to help with filling out applications for prescription drug assistance programs. Call or visit the one near you to find out if this service is available. Aroostook County Action Program, Inc Coastal Community Action Program Coastal Economic Development Community Concepts Kennebec Valley Community Action Program
101 Water Street, PO Box 1529 219 Cony Road, RR#7, Box 1103 26 Mary Street Penquis Community Action Program Peoples Regional Opportunity Program Waldo County Committee for Social Action Washington-Hancock Community Agency Western Maine Community Action, Inc. York County Community Action Corporation Community Health CentersArthur Jewell Community Health Center Ashland Health Center Belgrade Regional Health Center Bethel Family Health Center Bingham Area Health Center Bucksport Regional Health Center DFD Russell Medical Center Donald Walker Health Center East Grand Health Center Eastport Health Care Fish River Rural Health Systems Fish River Rural Health Systems Harrington Family Health Center HealthReach Community Health Center Indian Township Isleboro Health Center Kathadin Valley Health Center Lovejoy Health Center Madison Area Health Center Mount Abram Regional Health Center Penobscot Indian Health Department Pleasant Point Health Center Rangeley Region Health Center Regional Medical Health Center at Lubec Richmond Area Health Center Rural Health Centers of Maine Migrant Health Program Sacopee Valley Health Center St. Croix Regional Family Health Center Sheepscot Valley Health Center Stockton Springs Regional Health Center Strong Area Health Center Western Maine Family Health Department of Health and Human Services (DHHS) OfficesRegion IBiddeford Portland Sanford Region IIAugusta Farmington Lewiston Rockland Skowhegan South Paris Region IIIBangor Calais Caribou Dover-Foxcroft Ellsworth Fort Kent 92 Market StreetFort Kent, Maine 04743 207-834-7700 Toll Free - 1-800-432-7340 Local/Out-of-State TTY1-800-606-0215 FAX - 207-834-7701
Houlton Machias Drug CompaniesYou can ask your doctor, hospital or health center to help you get free medications from the following list of drug companies. Your health care provider can help you contact other manufacturers not listed here. 3M Pharmaceutical 1-800-328-0255 Abbott Laboratories...1-800-441-4987 Aventis Pharmaceuticals..1-800-221-4025 Bayer 1-800-998-9180 Boehringer Ingelheim 1-800-556-8317 Bristol-Myers Squibb - 1-800-736-0003 Dupont 1-866-824-4747 Dura Pharmaceuticals 1-888-859-8583 Forest Pharmaceuticals 1-800-851-0758 Glaxo Wellcome 1-888-825-5249 Lilly Cares 1-800-545-5979 Merck & Company1-800-994-2111 Novartis Pharmaceuticals....1-800-277-2254 Parke-Davis.1-800-438-1985 Pfizer ...1-800-438-1985 Roche Labs....1-800-285-4484 SmithKline Beecham....1-888-493-6756 Takeda Pharmaceuticals 1-877-825-3327 Wyeth 1-800-568-9938 HIV/AIDS Service OrganizationsAIDS Lodging House Coastal AIDS Network Downeast AIDS Network 5A Water Street Eastern Maine AIDS Network Frannie Peabody Center Saint Mary's Regional Health Center Indian Health ServicesPenobscot Indian Health Services Maliseet Health Center..207-532-2240 Micmac Family Clinic....207-764-7219 Pleasant Point Health Center Indian Township Health Center INTERNET RESOURCESAccess to Benefits Coalition Centers for Medicare and Medicaid Services CHAMPVA for Life DirigoChoice Legal Services for the Elderly Maine Department of Health and Human Services NeedyMeds Northeast Region TRICARE Contractor Office of Elder Services Pharmaceutical Manufacturers Association Social Security Administration www.va.gov Legal Services for the ElderlyLegal Services for the Elderly (LSE) provides free legal services state-wide to people age 60 and older and Health Insurance counseling to all Medicare beneficiaries. They provide a hotline staffed by attorneys. For more information call: V/TTY 1-800-750-5353 MEDHELP MaineIf you are looking for information and help to apply for Patient Assistance Programs, ask your doctor or other health care provider to call MedHelp Maine . Upon physician referral, prescription assistance coordinators will help people to apply for Patient Assistance Programs offered by many drug manufacturers. Each has its own eligibility guidelines (rules about income, resources, Part D enrollment, etc.) and application forms. 1-888-283-9883 (toll-free) MedHelp Maine PROGRAM LOCATIONS –
Veterans ServicesTogus Patient Advocate For more information, call or write:
Section 3 - Consumer TipsConsumer Buying TipsWhen you fill a prescription, rememberIf you have a low income you may be eligible for savings through the Low Cost Drugs for the Elderly and Disabled (DEL) program. Call your Area Agency on Aging at 1-877-353-3771 for help to apply for prescription drug assistance. Always ask about generics. Ask your doctor for samples. Before you fill your prescription: Tell the
pharmacist if you have drug coverage through private
insurance.
There can be a big difference in the price of medications. It's good to shop around and compare prices at different pharmacies. If you "shop around" for the best price, be sure the pharmacist knows all the drugs you are taking, including over-the-counter ones. If you find a lower price, talk to your regular pharmacist. They may be willing to match the price offered by another pharmacy. It is OK to get less than the full prescription. You may want to see how well the drug works or check for allergic reactions before investing in a large order. Or, you may not be able to afford to buy the whole amount at one time. Ask your physician for a four or five day supply, or tell the pharmacist how much you want. Pharmacists can give you less of the medication than what is requested in the prescription. Ask if there is a less costly way to fill the prescription. Sometimes the cost of a 40 mg, 20 mg, or 10 mg tablet is exactly the same. The pharmacist may be able to help you save by, for example, cutting a 40 mg tablet in half for the consumer who has a 20 mg dose. If you are a Veteran, be sure to contact the Veterans Administration to see if you can get your prescriptions through the VA. Medicare-eligible military retirees who are enrolled in TRICARE Senior Pharmacy Program will have prescriptions costs covered by the program. However, you will be responsible for an annual deductible and cost share. Understanding Your PrescriptionsAdapted from Talking With Your Doctor: A Guide For Older People. National Institute on Aging/National Institutes of Health. September 2000. When your doctor writes you a prescription, it is important that you are able to read and understand the directions for taking the medication. Often doctors or pharmacists use abbreviations that may not be familiar. The following are a list of some of these abbreviations and what they mean.
Remember to ask your doctor or pharmacist if you have questions about your medications or how you should take them. Some questions to ask include:
Focus on Medications: helpful HintsAdapted and reprinted with permission from the Northeast Health Care Quality Foundation (Medicare Quality Improvement Organization).
MEDICATION RECORDIt's a good idea to keep a list of all the medicines you take. Use this chart and include both prescription and over-the-counter (OTC) drugs like Tylenol, aspirin and vitamins. Keep the chart current by erasing or crossing out the ones you no longer take. Be sure to mark any changes in the amount you take and the times of day you take it. Download an Adobe PDF version. Medication Record for:____________________________________
For more information about this program and other services to help older people in Maine, call: Office of Elder Services
The Department of Health and Human Services does not discriminate on the basis of disability, race, color, creed, gender, age or national origin in admission to, access to, or operations of its programs, services or activities, or its hiring or employment practices. (207) 287-3488 voice This information is available in alternate formats upon request. This publication has been created or produced by the Maine Department of Health and Human Services, Office of Elder Services, with financial assistance, in whole or in part, through a grant from the Centers for Medicare and Medicaid Services, the federal Medicare agency. |
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