Kathleen G. Kane - Pennsylvania Office of Attorney General - Protecting Pennsylvanians

 Click for the Spanish Translation

IMPORTANT INFORMATION ABOUT THE MEDICARE PRESCRIPTION DRUG DISCOUNT CARD

Reports have already surfaced across the nation about scam artists capitalizing on confusion surrounding the new Medicare prescription drug discount card. The Attorney General believes that the best protection against health care fraud is for seniors to be informed consumers. The following information should help you understand this new Medicare benefit.

WHAT IS THE Rx DRUG DISCOUNT CARD AND WHAT CAN IT DO FOR ME?

Between June of 2004 and the end of 2005 (when the new Medicare Part D drug benefit begins), private companies ? known as card sponsors ? will offer discount drug cards approved by Medicare. Each Medicare beneficiary (who is not already receiving prescription drug benefits under Medical Assistance) will be able to choose from cards offered by at least two companies approved by Medicare. You will receive a card that will be marked with Medicare's seal of approval. Medicare-endorsed cards must meet certain guidelines, such as offering discounts on at least one drug in each therapeutic class, and having an adequate pharmacy network within the beneficiary's service area. Each company's card may offer different choices of prescription drugs (called formularies), and the individual will have to decide which card provides the greatest benefit.

WHAT WILL THE Rx DRUG DISCOUNT CARD COST AND HOW MUCH WILL I SAVE?

The discount card will cost no more than $30 per year. It will offer savings of 10 to 15 percent on prescription drug costs, on average.

WHEN WILL I BE ABLE TO PURCHASE A CARD AND BEGIN TO SAVE ON MY PRESCRIPTION DRUGS?

Medicare will approve private companies (like insurance companies, managed care organizations and pharmaceutical companies) to sponsor discount drug cards in March, 2004. These "card sponsors" will be able to advertise beginning in April, 2004. Seniors will be able to sign up for the card of their choice in May, 2004. The program will become effective in June, 2004.

HOW DO I PURCHASE A DISCOUNT CARD?

Card sponsors will provide application packages that will be available on the Internet and through other sources like direct mail. These application packages must provide the following information:

  • The enrollment fee (not to exceed $30 per year);
  • The negotiated prices offered for covered discount card drugs;
  • Discounts offered on over-the-counter drugs, if any; and
  • Other products and services offered under the endorsed card, if any.

The card sponsor's material must comply with the Information and Outreach Guidelines published by the Center for Medicare and Medicaid Services ("CMS").

HOW CAN I FIND OUT WHICH CARD IS BEST FOR ME?

The official Medicare website ? http://www.medicare.gov ? will publish a list of cards beginning in April 2004. The website will also have a card comparison tool that will help you determine the discounts offered by each card. You may also call: 1-800-MEDICARE for assistance.

DO I HAVE TO APPLY FOR A CARD?

No. Participation in the Rx drug discount card is voluntary.

MAY I APPLY FOR MORE THAN ONE MEDICARE DISCOUNT CARD?

No. You may only have one Medicare-endorsed Rx drug discount card. If you have other discount drug cards, you may keep them as long as they are not endorsed by Medicare. You may only use one discount card for each drug purchase ? your pharmacist may be able to help you decide which card offers the best discount.

WHAT IF I WANT TO SWITCH TO ANOTHER MEDICARE Rx DRUG DISCOUNT CARD?

You may switch cards between November 15 and December 31, 2004.

WHAT IF I WANT TO CANCEL MY CARD?

You may voluntarily cancel or disenroll from the Rx discount card program at any time, by contacting the card sponsor. The card sponsor must maintain a toll-free customer call center that is open during usual business hours. Depending upon the reason for the cancellation/disenrollment, the beneficiary may have to re-apply for the Medicare Rx Drug Discount Card should he or she want to enroll in another endorsed program for 2005.

WHAT IF I HAVE PROBLEMS WITH THE CARD?

Each card sponsor must establish and maintain a grievance process that will track and address complaints about any aspect of its discount card program in a timely manner.

CAN MY APPLICATION BE REJECTED?

Yes, if you already have Medicaid or Medical Assistance drug coverage; or you already have a Medicare Rx drug discount card (through another card sponsor); or you are ineligible for Medicare.

WHAT ELSE SHOULD I KNOW ABOUT THE Rx DISCOUNT CARD?

Transitional assistance is available for low-income Medicare beneficiaries. If you are eligible for this special assistance, CMS will pay the annual enrollment fee to the card sponsor on behalf of the Medicare beneficiary. This special assistance entitles beneficiaries to payments by the federal government of 90 to 95 percent of their drug costs up to $600 in calendar year 2004 and $600 in calendar year 2005. Eligibility for this transitional assistance program is based upon income. You must use a special application for these low-income benefits. Contact Medicare for more information on income eligibility requirements.

BE CAUTIOUS WHEN CHOOSING A MEDICARE Rx DRUG DISCOUNT CARD. BEWARE OF COMPANIES PROMOTING LOOK-ALIKE PRODUCTS: CARDS THAT APPEAR TO BE MEDICARE-ENDORSED CARDS AND MAY EVEN USE SYMBOLS WHICH LOOK LIKE THE GOVERNMENT'S LOGO, BUT ARE NOT.

DO NOT GIVE OUT PERSONAL IDENTIFYING INFORMATION, MEDICAL OR FINANCIAL, UNLESS YOU ARE SURE THAT THE COMPANY IS ENDORSED BY MEDICARE. WHEN IN DOUBT, CHECK WITH MEDICARE AT 1-800-MEDICARE (1-800-633-42273) TO MAKE CERTAIN THAT THE CARD SPONSOR IS APPROVED BY CMS.

AND REMEMBER, THE MEDICARE Rx DRUG DISCOUNT CARD OFFERS DISCOUNTED DRUG PRICES. IT IS NOT INSURANCE AND IS NOT REGULATED BY ANY STATE AGENCY.