Advice for Medicare Beneficiaries
Bring key information to pharmacy, save RX drug receipts
Medicare beneficiaries who encounter problems filling their prescriptions under their new drug plans have several options to help them through the first few weeks of their coverage, according to guidance from members of the Nebraska Medicare Prescription Drug Coalition.
“Many beneficiaries have reported that they are experiencing problems when they visit the pharmacy, typically that they are not in the system,” said Connie Benjamin, AARP Nebraska State Director. “If they have not received their drug plan ID card, they should still be able to get their prescriptions from their pharmacy. But to be on the safe side they should be prepared to purchase a limited quantity of their drugs out of pocket until they receive their card.”
The coalition advises beneficiaries to bring three items with them to the pharmacy:
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The enrollment acknowledgment letter that was sent by their new Medicare prescription drug plan provider;
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Their government-issued Medicare and Medicaid ID number (if also on Medicaid); and
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Some form of ID (Photo ID if possible, but for those without driver’s licenses, state issued IDs, utility bills, Social Security cards or passports may be helpful).
“It is our understanding that Medicare has instructed pharmacies to honor policies if a person has those three pieces of information,” Benjamin said. “However, if beneficiaries are still experiencing a problem, we urge them to call Medicare at 1-800-633-4227 or their plan provider for help. They should also save their receipts so they can later get the problem corrected through their plan.”
In Nebraska, all Medicare prescription drug plans will provide transitional coverage for at least a 30-day supply of prescriptions that are not on a plan’s formulary, which is a covered list of prescription drugs. That will allow people time to contact their doctor to change their prescriptions, said Jina Ragland, director of the Nebraska Senior Health Insurance Information Program.
However, beneficiaries have the right to request that their plan cover a “medically necessary” drug not on its formulary. The beneficiary, someone they appoint, or their prescribing doctor may request an exception from the drug plan.
The doctor will need to tell the plan in writing or by phone why the person needs the particular drug. The plan must respond to the request within 72 hours or within 24 hours if a doctor certifies that someone’s life or health is in jeopardy, Ragland said.
Furthermore, Benjamin explained that low-income “dual eligible” beneficiaries enrolled in both Medicaid and Medicare may change prescription drug plans at any time during the year, with the change taking effect on the first day of the next month. Dual eligible beneficiaries who did not choose a plan were randomly assigned to a plan which may not cover all of a person’s drugs. She stressed that these individuals need to make sure they are enrolled in a suitable plan and can receive further direction by calling the state Medicaid office at 1-800-685-5456.
While drug coverage started Jan. 1 for those already enrolled in a plan, many older Nebraskans are still reviewing their plan options and have until May 15 to enroll.
“We encourage people to do their homework,” Ragland said. “Learning about the new Medicare prescription drug benefit is time well spent because enrolling in an appropriate plan can reduce a person’s drug bill by as much as 47 percent.”
Beneficiaries can review the different prescription drug plans by visiting www.medicare.gov , or by calling Medicare toll-free at 1-800-633-4227 or the Senior Health Insurance Information Program at 1-800-234-7119.
The Nebraska Medicare Prescription Drug Coalition represents over 80 nonprofit and professional organizations, state and local agencies and volunteers. The coalition aims to help Medicare beneficiaries understand the new drug benefit and assist them with application and enrollment.
