Prescription Advantage, changes on the horizon
By Margie Ware
Massachusetts is fortunate to have Prescription Advantage (PA), the most comprehensive State Pharmaceutical Assistance Program (SPAP) in the nation. Prescription Advantage grew out of the Commonwealth’s first efforts to provide some relief to seniors for high prescription drug costs. Senior Pharmacy and Pharmacy Plus were entitlement programs that reimbursed low and moderate-income seniors for out-of-pocket prescription drug expenses. Prescription Advantage was introduced in 2001 as a full-scale insurance program for all elders in the state.
Since the introduction of Medicare Part D in 2006, PA has continued to act as a supplement to the Federal program, filling in the gaps for seniors who hit the “doughnut hole,” the coverage gap reached when a person has used more than $2,500 or so in medications.
Prescription Advantage will still play that role in the lives of its members, but some other aspects of the program will be trimmed in response to the budget deficit currently facing the state.
The two most obvious changes to the program will be evident to members early in the next year. Most PA members are now in programs with a deductible, which in most cases, will be $295 in 2009. In prior years, PA members did not pay full price for their medications during that initial period. PA limited their co- pays to either $7 generic/$18 brand name or $12 generic/$30 brand name for those in high-income categories. This part of the PA “safety net” will disappear in 2009. In addition, in Phase 2 of the Part D process, when the Federal government is paying 75% of an individual’s drug costs, PA members will always pay the co-pay designated by their plan. Previously, those co-pays were limited to the above-referenced caps, in the cases where the plan co-pay exceeded those amounts.
One of the most important aspects of Part D is coverage “in the gap.” This will continue and will remain at the standard co-pay rates. This is great news for PA members, because there was the possibility that the plan might need to make even more drastic cuts, and we are fortunate that those were avoided.
Prescription Advantage remains a great benefit to Massachusetts seniors. If you are not a member and your income is less than $31,000 as a single individual or $42,000 as a couple, we urge you to consider joining this plan, which is provided at no cost.
For additional information, contact the Elder Services SHINE Program at 499-0524 or 1-800-544 5242 or contact your local Council on Aging.
Margie Ware is Elder Services’ Regional SHINE Program Coordinator.
