Originally created 04/28/04

Medicare drug card program to begin with many choices



WASHINGTON -- Every low-income Medicare beneficiary who qualifies should sign up for a Medicare-approved drug discount card, which provides $600 in government aid to buy prescription medicines.

For everyone else, the decision to buy a discount card - and which one - is not so simple.

Beginning Thursday, the Medicare Web site will provide drug price comparisons and tell Medicare recipients where they can use the various cards. The same information will be available from operators at 1-800-MEDICARE.

Enrollment begins May 3, and the cards can be used starting in June.

The Bush administration is set to launch its second round of Medicare advertising in coming weeks, having been stung by criticism that its first installment was political and not very informative. Companies can start marketing the drug cards in May.

For low-income people who are not already receiving Medicaid, the decision to get a card is easy. It won't cost anything and it comes with $600 to spend on prescription drugs this year and another $600 in 2005.

Which card to pick is another matter.

Even seasoned counselors are struggling to come up with easy-to-understand answers for Medicare recipients of all incomes. Several groups that advocate for older people as well as state health insurance assistance programs are offering help.

"We are struggling with how to spend less than an hour of a counselor's time helping someone make a decision," said Robert M. Hayes, president of the Medicare Rights Center in New York. "It may well be that there is no reasonable process to make an informed decision given the complexity of the market."

Although Medicare announced in March that 28 companies had been approved to offer discount cards, that number has risen. There are now 36 national cards and an additional 35 that can be used in different parts of the country.

The cards, which will cost up to $30, may offer discounts on different drugs and in differing amounts, although at least one drug in each of 209 categories must be included. Different pharmacies will accept different cards.

"Companies will set the conditions for their cards' use. For example, they may say, 'We'll give you a break on Lipitor, but only if you buy it at Walgreens,"' Mariette Klein, AARP's associate director for Virginia, said at a recent information session attended by 150 people in Manassas, Va.

Medicare officials say they are confident that the price comparison Web site and telephone help will enable older and disabled Americans to sort it all out.

"Seniors should call 1-800-MEDICARE or go to Medicare.com to shop and compare," said Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. McClellan said people could sign up for a card right away or wait a few weeks since the cards can't be used until June.

At least one Medicare official, however, suggested waiting, noting that the government is still considering approving more cards and that once enrolled, people have to stick with one card until the end of the year.

AARP's Klein also suggested waiting. "I caution you about jumping on the first offering you get," she said.

Medicare recipients who already have prescription drug coverage through former employers or state plans probably will not find the cards worthwhile, government officials and health care analysts say.

The government estimates that more than 7 million people, most of them now without prescription drug insurance, will sign up for cards. More than 4 million people are expected to qualify for the low-income subsidy.

Pennsylvania and New Jersey are trying to make it easy for its retirees by automatically enrolling those who are eligible for the $600 in aid. Tom Snedden, director of Pennsylvania's PACE prescription drug program, said the state also is offering every Pennsylvanian on Medicare a drug card free of charge.

McClellan, speaking on Capitol Hill earlier this month, said people who use the drug card "will no longer have to pay the highest prices in the world."

In other settings, McClellan has said the cards are a step toward making prescription drugs more affordable, along with the wider use of generic drugs and the Medicare prescription drug insurance program that begins in 2006.

The official administration estimate of savings with the drug card also has been more restrained. It forecasts a savings of 10 percent to 25 percent off the retail price of prescriptions.

A survey of card sponsors found that the cards would produce average discounts of 17 percent for brand-name drugs and 35 percent for generic drugs, according to the Pharmaceutical Care Management Association, an association of pharmacy benefit plan managers.

Critics have said they expect more modest savings, noting that prescription prices are rising around 15 percent a year. In that context, said Gail Shearer, Consumers Union's health care expert, seniors might still save more by using existing drug discount cards or filling their prescriptions in Canada.

Even after choosing a Medicare-approved card, consumers with existing cards could still find it hard to discern whether they are getting the best deal possible, analysts said.

"Take all your cards to the pharmacy and ask the pharmacist which one is best," Klein recommended.

Some questions and answers about Medicare-approved discount drug cards, set to take effect in June:

Q: How do I get a card?

A: Beginning Thursday, Medicare will tell you how to contact companies offering drug cards in your area. Call Medicare at 1-800-633-4227 or visit its Web site, www.medicare.gov. You must request an enrollment form from the companies.

Q: How do I choose the best card for me?

A: You will need to make a list of all the medicines you take regularly. Either through the Internet or via telephone, Medicare will help you compare the prices for your drugs offered by the different cards. There will be at least 36 cards available nationally and another 35 that can be used in parts of the country.

You also will want to determine whether you can use your regular pharmacy or one nearby with the card that seems best. You should consider whether generic substitutes or filling your prescriptions through the mail would save money. State health insurance assistance programs, AARP, the Medicare Rights Center and other groups also are offering help.

Q: How much does a card cost?

A: No more than $30.

Q: Is there aid available for the poor?

A: Yes. You may be eligible for $600 in government aid this year and another $600 in 2005 if your annual income is no more than $12,569 for an individual and $16,862 for a couple. You must specifically apply for the subsidy once you decide which card to choose. There is no fee for low-income cards.

Q: What if my prescriptions change or the prices offered by my card rise or my pharmacy stops accepting it? Can I change cards?

A: In general, not until next year. Companies can change their prices weekly. Medicare says it will monitor drug prices to watch for unwarranted changes and "bait-and-switch" schemes.

Q: If someone calls me offering a discount card and asking for my Medicare and Social Security numbers, should I provide them?

A: No. Companies are not allowed to call you on the telephone or visit your home to sell their cards. Never share such personal information over the telephone. Medicare officials said they are aware of alleged Medicare drug card scams in 13 states.

Some places to turn for help in choosing a Medicare-approved drug discount card:

Medicare (starting April 29): http://www.medicare.gov/AssistancePrograms/

Medicare telephone help: 1-800-MEDICARE (633-4227)

AARP prescription drug worksheet: http://assets.aarp.org/www.aarpmagazine.org-/promotions/discount-car d.pdf

Medicare Rights Center: http://www.medicarerights.org/

State health insurance assistance programs (Internet links and telephone numbers): http://hiicap.state.ny.us/home/link08.htm

On the Net:

Centers for Medicare and Medicaid Services: http://www.medicare.gov/AssistancePrograms/