State's Rx for Medicare gaps: some states have made long-term commitments to help their low-income citizens pay their out-of-pocket costs for Medicare Part D. For some it was a matter of life or death.

Author:Cauchi, Richard

In January, elderly and disabled Americans, many on medications for numerous diseases, were being overcharged or turned away without their pills while pharmacies struggled to get the information they needed to help them.

Some states took emergency action in those first weeks, making sure their citizens weren't falling through the cracks in the ambitious new federal prescription drug program that may eventually cover some 42 million people.

Connecticut, Maine, Massachusetts, New Hampshire, North Dakota and Vermont were ready in a matter of days, announcing plans to guarantee pharmacists that they would get paid for drugs that should have been provided through the Medicare plans. Within three weeks, 35 states had decided to pay for drugs or inappropriately high co-payments for low-income people who were having trouble getting the drugs they needed through Medicare as the program was launched.

"Every pharmacist knew that all the drugs were covered and that we would worry about who pays for it later," said Massachusetts Senator Mark Montigny. "Our new law is very clear."

In North Dakota, says Senator Judy Lee, lawmakers were working with pharmacists, Medicaid and Medicare to "make sure everyone gets what they need until the problems are resolved. We are doing everything we can to make sure this goes seamlessly for our seniors."


Not only did states step in with emergency coverage in January, many also saw a need to help citizens with prescription medicines years earlier.

Long before Medicare provided a drug benefit, many states had established their own publicly funded prescription drug assistance programs. By the end of 2003, 28 states were providing subsidized medicines to about 1.8 million seniors, people with disabilities, and some other low-income residents. These programs didn't follow any single model, and almost always depended on state appropriations.

Many of these State Pharmaceutical Assistance Programs (SPAP) laws required direct negotiated price deals or rebates with pharmaceutical manufacturers and were run day-to-day by a single state agency within a Department of Aging or Health. In the past few years, a dozen states added discounted prescription drug programs for higher-income seniors or other adults. Five states won the right to get some federal matching funds through so-called Pharmacy Plus Medicaid waivers.


For states with a strong history of pharmaceutical assistance, one clear challenge for 2006--after the transition period is over and the Medicare benefit is running smoothly--is to design simple and seamless state benefits that will add to and complement the new Medicare Part D program.

Twenty states are trying "wraparound" support to help low-income...

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