State reveals strategy to help seniors when Medicare plan starts

Monday, Sept. 19, 2005 | 10:12 a.m.

CARSON CITY -- The state has unveiled its strategy to try to protect an estimated 26,000 low-income senior citizens from higher-out-of pocket expenses for prescription drugs starting in January.

As the new federal Medicare program starts in January to provide drugs for seniors, state officials plan to coordinate the benefits of those on Nevada's Senior RX and Medicaid.

"We want to make sure no one is worse off," said Mike Willden, director of the state Health and Human Services Department.

The state wants to see the federal government pick up more of the drug costs for the elderly, he said. It could save the state $500,000 this fiscal year and $2.5 million in fiscal 2007.

Drug companies this week will disclose whether they want to provide prescription drugs to those enrolled in the Medicare Part D program in Nevada that starts in January. Seniors, if they want to sign up, will have to choose what program they want to enter.

There are more than 16,000 seniors in Nevadans who are covered by Medicare and also by Medicaid. They receive their prescription drugs free and pay no monthly premium.

These individuals will automatically be enrolled in the Medicare drug program. But the Medicare program will charge a monthly premium estimated at $32 and these seniors will have to put up $1 to $3 as a co-pay for every prescription.

The federal program also has a "donut hole" in which it will not pay for any prescription drugs for the patient when the yearly bill runs between $2,250 and $5,100 a year.

Under the plan outlined Thursday, the state will pay the monthly premium for these individuals, pick up the $1 to $3 co-pay per prescription and provide coverage of the donut hole. Willden said those people don't have the money to pay for the premiums, the co-pays and the "donut hole" because they are earning $6,000 or less a year.

The Senior RX program, started by Gov. Kenny Guinn in 1999 with money from the tobacco settlement, has more than 9,500 enrollees who are 62 and older, have incomes of less than $23,175 and meet the residency requirement of at least one year in the state.

These individuals don't pay any premiums or deductibles. But they must come up with a co-payment for their drugs. Drug coverage is limited to $5,000 a year. Most of these individuals would be required to sign up for the Part D Medicare drug coverage.

But the state plans to pay their monthly premiums and cover the cost of drugs in the donut hole, said Willden.

Those enrolled in Senior RX average about four prescription drug refills a month and pay an average co-payment of $68. That payment would drop in the coordinated program to anywhere from $27 per month to $45 per month depending on a person's income.

At the meeting of the Legislative Interim Finance Committee on Thursday, Assemblywoman Chris Giunchigliani, D-Las Vegas, said she was surprised that seniors average four prescriptions a month each.

Laurie Olson, program manager for Senior RX, said that some seniors are on 17 prescriptions a month, Sen. Bernice Mathews, D-Reno, quipped that Giunchigliani would find out about the need for prescription drugs when she reaches 71 years old.

Willden said it was not uncommon for those 70 and older in Senior RX to be on six medications for such ailments as high blood pressure, high cholesterol, digestive problems and arthritis.

Some legislators are worried that the federal government could increase the monthly premiums in the future and the state would have to pick up that cost. That's happened in other programs where the state ended up paying more of the bill than originally planned.

Senate Majority Leader Bill Raggio, R-Reno, directed that Willden meet with legislative staff to determine whether the state should pick up the whole cost of the monthly premium or should be it some lower percentage.

The issue will come before the Legislative Interim Finance Committee at its November meeting.