Prescription Drug Coverage for People with Disabilities

	The Issue	The Latest Scoop	Action Steps	Lead Contacts	More Information

The Issue

Prescription Drug Coverage will soon be available for people with disabilities that have Medicare under the new Medicare Part D Prescription Drug Benefit. Medicare Part D is a nation-wide, very expensive new program under Medicare introduced in the Medicare Modernization Act of 2003. It is complicated, has short timelines, and will affect different people in different ways.

If you have any form of Medicare, you need to pay attention and make some decisions. If you have no prescription drug coverage and high drug costs, it may be very helpful. People who are on both Medicaid and Medicare must participate.

Medicare Part D drug coverage begins January 1, 2006 if you enroll in November or December. Otherwise, it begins the month after you enroll.

If you have Medicare and Medicaid (Medicaid is also sometimes called Medical Assistance or Title 19, this includes MAPP, COP, and CIP participants, and people that have met their Medicaid deductible): starting January 1, 2006, you will receive drug coverage for most of your drugs under the new Medicare Part D Prescription Drug Benefit instead of from Medicaid. You will still need your Forward card because other services and some medications will continue to be covered under Medicaid. Benzodiazepines and barbiturates, which are excluded from Medicare Part D, will continue to be covered under Medicaid in Wisconsin.

Medicare Part D is made up of several private prescription drug plans. These plans only cover prescriptions drugs - other parts of Medicare and Medicaid will continue to provide coverage as before. Medicare Part D prescription drug plans will have a list of drugs they cover and a list of pharmacies where you can go to get your drugs. Information about the drug plans will be released in October, 2005.

There are extra protections for anti-psychotic, anti-depressant, anti-convulsant (seizure medications), anti-retroviral (HIV), anti-neoplastics (cancer and autoimmune), and immunosuppressant medications. Drug plans should cover most of these drugs and provide “uninterrupted access” to these drugs.

The Latest Scoop (Updated: 06/13/2006)

On January 1, 2006 an estimated half a million people with developmental disabilities nationwide transitioned from Medicaid prescription drug coverage to Medicare's new Part D prescription drug coverage.

More than six million people nationwide with Medicaid and Medicare coverage (dual eligibles), saw their Medicaid prescription drug coverage replaced on January 1, 2006 by the new Medicare Part D coverage, provided by private prescription drug plans (called PDPs).

More information about this change is available from the Wisconsin Coalition for Advocacy, Advancing Independence, Medicare, and the Medicaid Reference Desk.

There is also a valuable guide developed by the national Arc and UCP organizations called “Ensuring Continuity of Care for Dual Eligibles: A Guide to Transition From Medicaid to Medicare's Prescription Drug Coverage”.

United Cerebral Palsy and PhRMA have released "Navigating the Medicare Part D Prescription Drug Coverage Program". It is a guide for people with disabilities, benefits counselors, disability organizations and others on ensuring adequate and appropriate access to prescription drugs.

Part requires a monthly premium to be paid for this coverage. Anyone with Medicare can apply for “extra help” to reduce the monthly premiums, deductibles, and co-payments under Medicare Part D. Call Social Security toll-free for an application at 1-800/772-1213. Applications are also available in Spanish and directions to complete the application are available in 15 other languages. You can also apply online at www.ssa.gov. In addition, you can go to your local Social Security Office to have them help you with the application. If you think you might qualify or aren’t sure, apply.

If you have Medicare and Medicaid (Medical Assistance) or if you are enrolled in a Medicare Buy-in Program (QMB, SLMB, QI), you do not need to apply for the “Extra Help”. You should automatically receive this help. If you want to make sure that Medicare knows you do not need to apply for “extra help”, call toll-free 1-800-MEDICARE, and have your Medicare number ready.

Action Steps

1. If you are experiencing problems with the new prescription drug benefit, let your representatives know.
2. People who need help paying for prescription drugs should apply for “extra help” with social security if:
   
   a. They have Medicare
   b. They have low income and resources
   c. They do not also have Medicaid or a Medicare Buy-in program (these groups should receive the help automatically)

Lead Contacts

Aimee McCutcheon
Wisconsin Coalition for Advocacy
16 N. Carroll Street, Suite 400
Madison, WI 53703
608.267.0214
aimeemc@w-c-a.org

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More Information

• Issue alerts:
  • Search DAWN alerts on this topic
• Plain Talk
• Advocacy Resources:
  1. The Wisconsin Coalition for Advocacy’s Disability Drug Benefit Helpline Website
  2. State of Wisconsin Consumer Guide to Health Care: Prescription Drug Assistance Programs
  3. The Medicare Modernization Act of 2003 (MMA), Health Assistance Partnership
• Background Papers:
  • Kaiser Family Foundation Resources on the Medicare Prescription Drug Benefit
• Fiscal Information:
• Stories of Wisconsin's citizens with disabilities:
• Links to relevant disability information: