General Facts on Medicare Drug Benefits
Key Facts About Any Medicare Discount Card
What About the Drug Manufacturers, Will They Participate in Lowering the Beneficiary Cost?
How Are the Copayments Determined?
What Will Be the Cost of the Discount Card To the Beneficiary?
More information can be found by following these links
Discount Card Timeline
- March 28, 2004 - CMS will announce Medicare endorsed companies
- May 3, 2004 - Endorsed companies can begin advertising to beneficiaries/patients (upon CMS approval)
- May 3, 2004 - Beneficiaries can begin enrollment
- June 1, 2004 - Endorsed programs begin and discounts become effective
- November 15 - December 31, 2004 - Only open enrollment period for beneficiaries to change card programs
Key Facts About Any Medicare Discount Card
- Medicare Beneficiaries are to be eligible for discounts beginning June 1, 2004
- The program is scheduled to run through December 31, 2005
- Beneficiaries can ONLY enroll in ONE Medicare-endorsed discount card
- Patient's are not automatically enrolled in any discount card plan unless they are already part of a Medicare managed care plan
- All Medicare beneficiaries that are enrolled in either Medicare A and/or Medicare B and not currently receiving prescription benefits from TRICARE, a federal retiree program, state Medicaid or private insurance are eligible for a Medicare Approved Drug Discount Card Program. Additionally, if the income of the Medicare eligible beneficiary is below 135% of poverty level (single and have an income of less than $12,123, or married with a combined income less than $16,862), they may be eligible for a $600 subsidy from CMS, referred to as Transitional Assistance.
What About the Drug Manufacturers, Will They Participate in Lowering the Beneficiary Cost?
Manufacturers may participate in two ways:
- Discounts - Some Manufacturers may make available their existing low income or means tested programs, passing on 100% of very large discounts to the beneficiaries at the point of sale.
- Rebates - Some Manufacturers may make rebates available to CMS Endorsed Medicare programs to help reduce the cost to beneficiaries.
What About the Drug Manufacturers, Will They Participate in Lowering the Beneficiary Cost?
If the enrollee qualifies for Transitional Assistance and their income is less than 100% of the poverty level, the copayment will be 5%. If the enrollee's income is between 100% and 135% of the poverty level, the copayment will be 10%. This copayment will apply only during the time the enrollee is receiving their $600 subsidy. After the $600 subsidy is exhausted, the enrollee will be responsible for 100% of the discounted price. Enrollees who are not eligible for Transitional Assistance will be responsible for 100% of the discounted price.
What Will Be the Cost of the Discount Card To the Beneficiary?
Any Medicare endorsed Discount Card Program can charge up to $30 for enrollment. Beneficiaries who qualify for Transitional Assistance will have any applicable enrollment charges paid by CMS as part of their $600 subsidy.
More information can be found by following these links
Medicare-Approved Drug Discount Card Tip Sheet
Pricing and Eligibility Questions
Guide to Choosing a Medicare-Approved Drug Discount Card
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