Pharmacy Times

Untangling the Medicare Drug Discount Card Thicket

Author: Robert I. Garis, RP, PhD, and Judith Lee Kissell, PhD

The Medicare Prescription Drug Discount Card (discount card) is a voluntary program intended to give immediate relief to Medicare recipients' prescription costs. It operates from June 1, 2004, until January 1, 2006, when the Medicare Drug Benefit will begin. The pharmacist, with some preparation, can be a valuable resource to seniors enrolling in the program. This opportunity to serve the Medicare population can reinforce the image of pharmacy as the accessible professional. The following topics will facilitate pharmacists' counseling their patients concerning the discount card program.

Help on the Web?The Medicare Plan

Patients can be educated on how to discover useful information on their own. The search for a card program begins at the Medicare Web site, www.medicare.gov. At that site, select the search tool, Prescription Drug and Other Assistance Programs. Patients can also get information by calling 800-MEDICARE (800-633-4227). When patients provide their Medicare status, zip code, marital status, financial information, and the drugs they are taking, they will be sent to a site that, depending on their income, may recommend that they apply for further financial assistance. That same Web page contains the drug cards available for the patient's zip code and card sponsor's phone numbers, Web sites, and customer service hours. Be sure to tell patients that they will also have to fill out the card sponsor's application that will be available in May 2004. The card sponsor can charge patients up to $30 annually for the cards.

Financial Assistance for the Low-Income Patient

Patients may qualify with Medicare for additional assistance if they are not on Medicaid and have an income of $12,123 or less for singles and $16,362 or less for couples. Patients who qualify for assistance (they will be informed on the Web), will receive the discount cards at no cost, will be charged a lesser coinsurance of 5% to 10% of the drugs' discounted cost, and will also receive a $600 annual credit toward the purchase of drugs for 2004 and 2005. Money unused in 2004 is carried over to 2005.

Other Discount Cards

Patients who already have a discount card sponsored by a drug company or other entity may use either the Medicare discount card or the other card, depending on which is most advantageous. The drugs covered on each plan will vary, and patients will need to check with the card sponsors as to the formulary. Each card sponsor is required both to carry and to discount at least 1 drug in each of over 200 drug classes. The costs of the drugs on the discount cards will vary. The Department of Health and Human Services provides comparison prices, available April 29, 2004, at the Medicare Web site.

Cautions About Choosing a Card

Card selection should be based on the locations they serve, drugs they carry, and their discounted cost. You may want to alert your patients that card sponsors can change individual drugs, as well as the discount on these drugs, on a weekly basis. Under ordinary circumstances, patients can change cards only once during 2004/2005.

Dr. Garis is assistant professor, Creighton University School of Pharmacy and Health Professions. Dr. Kissell is assistant professor, Creighton University Center for Health Policy and Ethics.