State looks to coordinate Medicare, DEL drug plan

About 6,000 participants in Maine’s prescription discount program, Drugs for the Elderly and Disabled, known as DEL, should put off signing up for any of the new federal Medicare drug cards when private companies start making their cards available in the coming week.

The state Department of Human Services is looking for a company that will work with Maine officials to coordinate the federal plan’s $600 “freebie” drug credit for the lowest-income elders with DEL’s existing benefits. The state will save money by requiring DEL participants who qualify for the federal credit to use that program first, before tapping into the state’s DEL resources.

The Medicare discount card, which goes into effect June 1, will provide $600 in prescription medication to any Medicare participant with an income under 135 percent of the federal poverty limit. (FPL is set at $9,310 annually or $776 monthly for an individual.)

To get the credit, participants will have to contribute some out-of-pocket money.

Those with incomes under 100 percent of FPL will be responsible for a co-payment of 5 percent of the price of the drug. People with incomes between 100 and 135 percent of FPL will have a co-pay of 10 percent.

Once participants have received all of their $600 credit in medication, they will pay the full price of the drug minus whatever discount is offered by the company whose card they choose. Discounted prices are expected to be about 10 to 15 percent lower than regular retail prices.

Participants must choose only one card, but the cards available cover a different combination of medications. Low-income participants will pay no annual fee for their cards, but those with incomes over 135 percent of FPL will pay a $30 annual fee.

Under Maine’s DEL plan, participants pay 20 percent of the retail cost of a covered drug, plus another $2 “dispensing fee.” Covered drugs include those prescribed for a defined set of chronic conditions, including diabetes, heart disease, high blood pressure, lung disease and other conditions. Individuals with incomes of 185 percent of FPL or less are eligible for DEL. The program has about 30,000 enrollees; about 6,000 are eligible for the $600 Medicare credit.

Maine officials hope to identify a “preferred” Medicare card provider that will cover most of the same drugs available through DEL and that will track member use of the federal credit. DEL members who select a different card will have to keep track of their own drug expenses before DEL benefits will apply and may miss out on other advantages as well.

DHS says it hopes to identify a preferred card provider by the week of May 10 and will automatically enroll any DEL participants who do not specifically ask to be excluded by May 24.

More information about the Medicare plan’s impact on Mainers enrolled in DEL or other existing drug discount programs can be obtained by calling the Bureau of Medical Services at 1-866-796-2463.