In recognition of the absence or insufficiency of prescription drug coverage among Medicare beneficiaries, the high cost of prescription drugs, and the very low income threshold for Medicaid eligibility, 17 states have enacted programs that assist seniors with the purchase of prescription drugs. Most programs assist people who are 65 or over with incomes that are low, but not low enough to qualify them for Medicaid. Some programs also cover disabled individuals younger than age 65 who also have low incomes. The first state assistance programs began in 1975 in New Jersey and Maine. By 1999, 14 states operated pharmacy assistance programs for seniors and other eligible groups. These state programs vary in their size, eligibility criteria, benefit design, outreach efforts, budgets, and the administration of the benefits. The programs also share some common characteristics, most notably the procurement of rebates from drug manufacturers for the drugs purchased by the programs. Most states administer the senior pharmacy assistance programs separately from the Medicaid program, citing efforts to avoid the stigma that seniors may attach to the Medicaid program. In addition to the states with operational programs in 1999, additional state programs were enacted in 1999 and some states with existing programs passed program expansions. Still more states are considering legislation to create such programs, while other states with existing programs consider legislation to expand their programs.
Learning Objectives: At the conclusion of this session, the participant (learner) in this session will be able to (1)identify the states with pharmaceutical assistance programs and the relative sizes of the programs in terms of population served and budget, (2) describe and compare how programs are administered, (3) describe and compare the programs' eligibility criteria and benefit design, (4)describe programs' outreach efforts, and (5) identify the recent program expansions and the challenges facing new and existing programs
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.