Emergency measure by state of Illinois ensures no low-income Medicare Part D beneficiary is turned away at pharmacy

Seniors provided critical protection while kinks in federal program are addressed         

[JAN. 13, 2006]  CHICAGO -- Gov. Rod R. Blagojevich announced Thursday that Illinois will cover the cost of prescription drugs for dual-eligible citizens -- those enrolled in Medicare and Medicaid -- who were otherwise being turned away from pharmacy counters across the state due to glitches in the new federal Medicare Part D drug program. Adding to the ongoing efforts of the Blagojevich administration, this new safety net will ensure seniors and people with disabilities won't go without the drugs they need while the federal government corrects discrepancies with enrollees' records.

"It's unacceptable that any Illinois senior or disabled person who is entitled to Medicare's low-income drug coverage is leaving pharmacies without the prescription drugs they depend on," Blagojevich said. "Hopefully the glitches with the federal program will be worked out soon, but until then, we're going to take care of those who need their prescription drugs to remain healthy."

Since the new Medicare Part D program began on Jan. 1, many dual-eligible seniors and people with disabilities have been complaining that their pharmacists had no record of their Medicare Part D enrollment or that they were being charged prices they simply couldn't afford because the pharmacist did not have information on their low-income subsidy eligibility.

Now, if a pharmacist is having problems properly billing the Medicare prescription drug plans for someone who is dually eligible or if the low-income eligibility information is lacking, they can call or fax the individual's information to the Illinois Department of Healthcare and Family Services. On a case-by-case basis, the department's staff will work with the pharmacist to solve the problem. If the problem can't be fixed quickly, the state will cover the cost of the prescription drugs directly and then seek reimbursement from the prescription drug plan the patient is assigned to. Under the new system, no dual-eligible senior or disabled person will leave a pharmacy without the medications they need.

"We will continue to provide this critical protection to our seniors until the problems with the new Medicare program are worked out," said Barry Maram, director of the Department of Healthcare and Family Services.

After a pharmacist has provided the details of a case, Healthcare and Family Services, when necessary, will temporarily recode the individual's eligibility so that the claims will be paid directly by the department. Once proper billing information becomes available for the patient, pharmacies will void their claims to department and then bill the prescription drug plan directly.

Blagojevich continues to encourage senior citizens and people with disabilities to take advantage of the benefits of the Illinois Cares Rx and Medicare Part D prescription drug benefits. The governor also urged Illinoisans to use the state resources in navigating the new Medicare program's enrollment process.

The governor's ongoing efforts to help seniors through the Medicare Part D program are part of his long-standing effort to make sure that more people get more health care and better benefits; protect coverage for those who have health care; and help hospitals, doctors and nurses provide better health care. Under the Blagojevich administration, Illinoisans benefit from a wide array of programs designed to assist them with the high cost of prescription drugs: SeniorCare, Circuit Breaker (now Illinois Cares Rx), the Rx Buying Club and the I-SaveRx drug importation program.

[News release from the governor's office]