Drugs for the Elderly changes effective today
Copyright © 2003 Blethen Maine Newspapers Inc.
Starting today, about 36,000 low-income elderly and disabled people will no longer be able to buy certain drugs, including those used to treat cancer and depression, at their regular discounts.
People enrolled in the state's Drugs for the Elderly program can continue getting 80 percent discounts on certain drugs for 14 chronic illnesses such as diabetes and asthma. But all other drugs — for which they once could save up to 25 percent —must now be bought at full price or at lesser discounts.
The reduced benefits are a trickle-down effect of a Dec. 24 federal appeals court decision to overturn Drugs for the Elderly's companion program, Healthy Maine Prescriptions.
Mainers participating in Drugs for the Elderly — who earn under 185 percent of the federal poverty level — were allowed to participate in Healthy Maine, which offers savings of up to 25 percent on drugs for people making under 300 percent of the poverty level.
On Dec. 27, the state stopped offering Healthy Maine to 76,000 enrollees because the court indicated that Healthy Maine was an illegal expansion of Medicaid, an argument long-held by the pharmaceutical industry, which brought the suit.
But state officials said that members of Drugs for the Elderly could continue to use the program — until today.
"We felt initially that a reading of the opinion was limited to folks above 185 percent of the federal poverty level," said Newell Augur, spokesman for the state Department of Human Services. "But in fact, that's unfortunately not the case."
Augur said that the vast majority of Drugs for the Elderly members, if not all of them, have used the Healthy Maine benefit at least once since Healthy Maine was launched in June 2001.
Advocates for senior citizens said taking benefits away would be devastating.
"We're talking about folks who are at the bottom ladder of income," said John Carr, president of the Maine Council of Senior Citizens. "To lose (the Healthy Maine benefit) is a real shot in the pocketbook."
Some drugs once covered by Healthy Maine, such as the cancer drug tamoxifin, can still be bought at Medicaid price minus $2, through an agreement between the state and the drug's maker.
But hundreds of other drugs and treatments including the Efudex cream used by patients with pre-cancerous skin lesions and psychotropic drugs such as the antidepressant Remeron would need to be paid at full price.
Many enrolled in Drugs for the Elderly survive on under $1,000 each month, which they use to pay for housing, food and heating, Carr said. State officials worry that many of them will end up skipping on medicines to pay other bills.
DHS on Monday sent letters to the roughly 112,000 people who received benefits through Drugs for the Elderly, Healthy Maine, or both, with the bad news. The letters also express optimism that Healthy Maine would be fully restored.
On Tuesday, representatives from DHS and state Attorney General's Office met with federal Medicaid administrators in Baltimore to discuss Healthy Maine and what needs to be done to reinstate it. Senior staffers working for Maine's congressional delegation listened in on the meeting through conference call.
The U.S. Court of Appeals in Washington, D.C. ruled that Healthy Maine was unlawful because federal Health and Human Services Secretary Tommy Thompson never formally approved the state's 2 percent contribution to the cost of each prescription. In effect, the court said, drug makers were bearing the weight of the program through rebates they provided to the state.
The state hopes to get a new waiver for the program that would include a guarantee of a state contribution to Healthy Maine. While the Center for Medicaid and State Operations has requested more information about the program from the state, talks between parties have been "constructive," a spokeswoman said.
"Everybody was assured (at the meeting) that we and the state would work closely together," said Mary Kahn of the federal agency. She said another meeting is expected, though it has not been scheduled.
Drugs for the Elderly is available to people over age 62 or people over 19 who are disabled. Participants make too much to receive full Medicaid benefits — up to $1,366 for a single person, up to $1,841 for a family of two — and do not have prescription drug benefits.
The program covers 80 percent of the cost of drugs in the following categories: anticoagulation, arthritis, diabetes, glaucoma, heart disease, high blood pressure, high cholesterol, incontinence, Lou Gehrig's disease, lung disease, multiple sclerosis, osteoporosis, Parkinson's disease and thyroid disease.
For more information about the Drugs for the Elderly program, call 1-866-796-2463. The deaf or hard of hearing can call 1-800-423-4331 or 287-1828.