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[February 9, 2000 ]
On February 1, 2000, SB 393, the "discount prescription medication program" sponsored by State Senator Speier, was implemented. This law allows Medicare enrollees who now pay retail prices for their prescription medications to buy those medications at lower Medi-Cal rates. The law also may benefit Medicare enrollees in a UC-sponsored plan by allowing them this same option. It requires all pharmacies participating in the Medi-Cal program to charge Medicare enrollees the same discount price as Medi-Cal recipients (there is also a small processing fee, currently l5 cents per prescription).
Anyone who has a Medicare card is eligible. There are no forms to fill out. Every month, Medi-Cal establishes a Medi-Cal price for ALL drugs in the market. Medicare patients need only show their cards at pharmacies that fill Medi-Cal prescriptions to get ANY prescription for any drug in the market filled at the Medi-Cal price.
The following describes how the law should impact UC employees, annuitants and/or their family members who are enrolled in Medicare and in a UC-sponsored medical plan and have their prescription filled in California:
Core and the High Option Plans. Members should be able to pay the Medi-Cal discount price for the drug, then submit a claim to the plan for reimbursement.
UC Care and all HMOs. Members will pay the normal plan copayment; however, if a member presents a Medicare card in addition to their plan card and the pharmacy finds that the Medi-Cal discount price is less, the member should be charged the lesser amount.
The following questions are selected from the Medi-Cal Update—Pharmacy, Bulletin 479
Frequently Asked Questions (#4, 7, 8, 14 and 15)
Q. Who is eligible?
A. Anyone who has a Medicare card is eligible. That includes seniors over age 65 and those under age 65 who are disabled and have a Medicare card. You do not have to be on Medi-Cal.
Q. What drugs are covered?
A. Virtually every prescription medication is covered. There is no restricted formulary and there is no prior authorization. However, over-the-counter drugs are not covered under this new program.
Q. Can I go to any pharmacy I want to get the Medi-Cal price?
A. Only Medi-Cal pharmacy providers are required to charge a Medicare recipient the Medi-Cal prescription rate. The vast majority of pharmacies in California (over 5,000 pharmacies throughout California) participate in the Medi-Cal program. You may want to ask your pharmacy if it is a Medi-Cal provider. Additionally, a non-Medi-Cal pharmacy may be willing to charge a similar prescription rate.
Q. What if I already have prescription coverage, will this new program affect it?
A. You should continue to use your current insurance coverage if it is more advantageous to do so. This new program should not affect your current prescription coverage. The new program is intended for any prescription whose entire cost is paid for by the Medicare enrollee.
For example:
- If you have reached your yearly or monthly prescription limitation under your insurance program, and now have to pay for your prescriptions, you may want to use this new program.
- If your prescription insurance coverage doesn't cover a certain prescription drug, you may want to use this new program.
- If you have a deductible to meet before your coverage begins, you may want to use this new program.
Q. Will this program affect my Medicare coverage?
A. No, this program does not affect your coverage under the Medicare program.
For further discussion of the law and a frequently asked questions section, see Senator Speier's website.