Medicare payment for drugs

(Topic from archives: Originally posted 17:47:44 12/09/2001)

Has anybody used medicare to pay for drugs - Are they billed? How does it work? I need an answer fast - we are having insurance problems.

With few exceptions, Medicare does not pay for take-home medications. One exception is EPO if provided to a home dialysis patient under specific circumstances. Another exception is immunosuppressant medications. The National Kidney Foundation website has information about the most recent legislation expanding immunosuppressant medication coverage for people who are 65 or older or disabled. The fact sheet includes information on claim filing and can be found at http://www.kidney.org/recips/statement.pdf. There is also information on the NKF website about pending legislation that would extend Medicare coverage of immunosuppressant medications indefinitely for everyone. Talk with your clinic social worker or financial counselor and let him/her know about any difficulty you have paying for medications. There are pharmaceutical assistance programs that can help but each has its own guidelines and limitations.

You might qualify for Medicaid. It differs by state. It depends on your income. Call Social Security, or talk with your local office.

Drugs are becoming a problem in all the insurance programs. Ask for the customer relations department. They can often help you get your benefits. Many companies also have Patient Financial Assistance programs for people on low income who need higher limits or help with co-payments.

The Directory of Prescription Drug Patient Assistance Programs is published online by the Pharmaceutical Research and Manufacturer's Association of America (the trade organization for pharmaceutical companies). Their web site is http://www.phrma.org/searchcures/dpdpap/. If you know the name of the manufacturer, you can look for that manufacturer's program. If you know the name of the drug, you can enter that in the search field and it will tell you about the program that covers the drug or that there is no program for the drug. This web site also has links to www.rxassist.org, www.rxhope.org, and the Medicare web site where you can find out what programs for medication assistance are in your area.

There is also a web site called Needy Meds (http://www.needymeds.com) that has a searchable database of these program and even a comparison chart of new drug discount cards like TogetherRX, and individual pharmaceutical company's cards. The TogetherRX and Novartis' cards allow you to have the highest income.

As Joy posted, Medicaid covers medications for eligible individuals. Medicaid has a forumulary of medications that they cover. Others may be covered by exception (documentation of need). State Medicaid programs are generally located in the same office that administers welfare programs. The social worker at your facility should be able to give you information about Medicaid, application, and services. The Needy Meds web site also has links to state Medicaid offices.

Another resource if the patient is a veteran is the VA system. Veterans can receive medications for a very reasonable co-pay. You can read about VA health benefits on the web at http://www.va.gov.

Where can I obtain info. about TogetherRX. My mother has been putting off retirerment due to the cost of her meds. For health reasons she may no longer be able to work. I would like to do some research on available programs for seniors.

Thank You for any assistance.
JA

1) You can read about the TogetherRx drug discount card at http://www.together-rx.com.

2) To see a comparison of this and 4 other discount drug cards, look on http://www.needymeds.com under "Pharmaceutical Discount Card Comparison."

3) On the Medicare web site at http://www.medicare.gov you can search a database of prescription drug assistance programs by zip code or state and also find links to other helpful resources for medication assistance.

Is there payment by Medicare for steriods prescribed for a patient when Nebulizer meds are not enough to aid patient in breathing? If not there should be.

Medicare doesn't pay for most medications that you take at home. Write President Bush, your senators and representative to let them know you'd like a drug benefit to be part of Medicare. This is being debated in Congress now and if Congress passes a bill, the president will need to sign it before it becomes law.

I'm not a medical professional to answer about drugs/diseases..but if you are looking for such informations you may try forums like http://www.globalthreads.com/forum and http://www.drugs.com/forum
There are a lot of members who are ready to help you with answers to drugs or diseases related questions.

[Beth Witten MSW ACSW]

This is a very old thread and changes are happening right now with Medicare drug coverage. Although anti-rejection medicines and other drugs that Medicare has been paying for will still be paid for the same way (under Part A or Part B), Medicare will start helping to pay for other prescribed drugs starting January 1, 2006. Coverage is available through insurance plans approved by Medicare. Unless you have limited income and assets, you will have to pay a premium and you may pay a deductible and will probably pay part of the costs of your covered drugs. If you have limited income you may get this coverage without a premium and for just a small co-pay per prescription. You can read about this new coverage and how it relates to people with kidney disease at www.kidneydrugcoverage.org.