February 11, 2000


New Law Helps Bridge The Medicare Prescription Coverage `Gap

By Senator Dede Alpert

There are an estimated 1.3 million Californians who are Medicare patients but who do not have an HMO prescription drug plan to provide financial assistance with the rising costs of prescription medications. Lacking this drug coverage, those on Medicare have been forced to pay full retail prices for their prescriptions. Given that many Medicare recipients are senior citizens on fixed incomes, many have had to face the difficult choice of purchasing needed medications or being able to afford groceries and other basic expenses.

Thanks to a new law, the state's senior and disabled communities will no longer face this unconscionable choice. Senate Bill 393, signed into law last year and which became effective Feb. 1, requires pharmacies participating in the Medi-Cal program to charge Medicare recipients no more for a prescription drug that what Medi-Cal reimburses the pharmacy for the same prescription. The average savings for seniors on Medicare will be between 10 percent and 40 percent. A senior citizen on Medicare with a monthly prescription bill of $350, for example, could save as much as $128 per month with this new program in place.

The beauty of this new prescription coverage is its simplicity. It does not create a huge bureaucracy or administrative overlay. A patient need only present his or her Medicare card and a valid prescription to a pharmacy that accepts Medi-Cal patients. Patients continue to pay for their own medications, but at the reduced rate, which is equal to the amount the state would reimburse the pharmacy for a Medi-Cal prescription. Virtually every prescription medication is covered. There is no restricted formulary. There is no need for prior authorization. There is no paperwork for the consumer.

Anyone who has a Medicare card is eligible to participate in the program. That includes seniors over age 65 and those under age 65 who are disabled and have a Medicare card. It is not necessary to be on Medi-Cal to take advantage of the savings the new law provides. For those patients who have other prescription coverage but have reached their annual limit for medication payments, or who need a prescription that is not included in the HMO plan, this service helps them, too, providing needed flexibility and financial assistance.

Medicare recipients who want to know more about the Medi Cal reimbursement rate for a particular drug may ask their pharmacy for a copy of the price inquiry information sent to the pharmacy by Medi-Cal. For more information about the program, Medicare recipients should contact the California State Board of Pharmacy at 916-445-5014, extension 4010.

(* Senator Alpert would love to hear from you. Contact her online at senator.alpert@sen.ca.gov, or write to her at State Capitol, Room 5114, Sacramento, CA 95814.)

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