One of the common methods of paying for prescription drugs is through private health insurance. Private health insurance can be provided by your employer or the employer of your spouse or certain family members, or purchased through a state or federal marketplace, or a private marketplace.
Health insurance plans vary by employer and insurance company, and pricing may vary based on a number of factors. Most plans, however, offer some prescription drug coverage. To find out what medications are covered and what they may cost, review the information provided by the employer, visit the insurer’s website or call them directly.
It is important to note that most health insurance plans do not cover the entire cost of medication. Prescription drugs may fall into certain price tiers with set co-pays at each level.
Medicaid is a state health insurance program for people with low income. Also known as HUSKY, it provides a comprehensive health care benefits package which includes prescription drug coverage.
Eligible individuals enrolled in HUSKY A, C and D can receive most of their medications at no cost while HUSKY B members may have a co-payment requirement. HUSKY doctors prescribe generic drugs when available.
Learn More: Visit the HUSKY Healthcare website for more information, how to qualify and how to apply.
Some individuals are eligible for and enroll in both Medicaid and Medicare. In this case, guidelines for prescription drug coverage will change. Medicaid will no longer cover the costs of most medications; it will instead be covered by a Medicare Part D drug plan.
Go here for more information on how dual-eligibility affects prescription drug coverage.
Medicare Prescription Drug Coverage
Medicare Prescription Drug Coverage is available to everyone who has Medicare Part A and/or Part B. While neither Part A nor Part B covers the cost of outpatient prescription drugs, there are two main options available to get that coverage. The first is the purchase of a stand-alone Medicare Part D prescription drug plan to supplement Parts A and B. Most states, including Connecticut, have between 20 and 30 different Part D plans available for purchase from private insurance companies. Premiums, deductibles and co-pays can vary widely among the plans, so it’s best to compare the plans in light of your budget and projected prescription use.
The second option is enrollment in a Medicare Advantage plan (also known as a “Part C” plan.) Most Medicare Advantage plans cover all Medicare benefits, including drugs, and are also sold by private insurance companies. Premiums and coverage also differ for these plans.
It’s advisable to re-evaluate Medicare coverage each year during the annual “open enrollment” period. This is when individuals may enroll in, switch, or depart from Medicare Advantage plans and the Medicare Part D prescription drug plan. Your current plan or your medications may have changed and a different plan may better meet your needs or your budget in the following year.
Learn More: Visit Medicare.Gov for more information.
Or Contact CHOICES: Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility Screening. Visit the CHOICES website or call 1-800-994-9422 for information, referrals, eligibility screening and counsel.
Extra Help paying for Medicare Part D
Financial assistance is available to cover some or all of the costs of Medicare Part D. Extra Help, also known as the Low-Income Subsidy (LIS), is a federal program that covers some or all of the costs of monthly premiums, deductibles and cost-sharing for a Medicare Part D plan.
Most people qualify for LIS because they are enrolled in the Medicare Savings Program or HUSKY Medicaid insurance. The Medicare Savings Program pays the Medicare Part B premium and may also pay for the deductibles and cost-sharing of Medicare Part A and B benefits. Learn more and apply for the Medicare Savings Program here.
Some people choose to enroll in LIS through Social Security if their income and assets meet the financial criteria. Go here to apply for LIS or call Social Security at 1-800-772-1213.
The Department of Veterans Affairs Pharmacy Benefits Management (PBM) Services offers a variety of services to address the pharmacy and health care needs of veterans enrolled in the VA healthcare system. In combination with a health care team, PBM services aim to provide reliable medication information, resources and learning opportunities to improve a patient’s overall health.
Because the healthcare system is very complex, it may be helpful to consider the VA PBM service as a middleman in the process of connecting veterans with the prescriptions they need and delivering them in an efficient manner at an affordable rate. Automated facilities across the United States process veterans’ prescriptions and deliver them through mail order.
Eligible veterans order prescriptions online and register to manage refills. From the MyHealthVet site, individuals can place orders, review their medication list, track order status and more. Prescription drugs are mailed directly to the buyer.
The VA PBM is responsible for the following:
- Ensure medication is taken as prescribed.
- Manage prescription drug lists, so veterans know what medications are covered through their health plan.
- Negotiate with vendors to provide affordable prescription drugs and optimize savings.
- Improve the safety of medication administration.
Learn More: Visit the Veterans Affairs Pharmacy Benefits Management website for more information.
VA Medication Reconciliation
Medication reconciliation is a comprehensive review performed by veterans and their health care team to review the medicines they are taking.
Veterans are encouraged to practice regular medication reconciliation to maintain a steady record of the medications and supplements they take. In doing so, the health-care team can identify biological changes and prevent problems before they happen and enable the veteran to be an active participant in managing their health.
In the event you don’t have private or public insurance or your policy doesn’t cover needed medications, there may be help available to defray costs. Here are additional assistance programs offered by pharmaceutical companies and nonprofit groups:
- The Partnership for Prescription Assistance (PPA) is an online database containing pubic and private programs which may offer medicines at no or low-cost. The PPA’s free, online service has a four-step process that enables users to quickly learn what assistance programs are available and select those that best suits their needs.
- NeedyMeds: A non-profit organization that maintains an extensive database of information about patient assistance programs, state assistance, drug discount programs, and free or low-cost medical care. You can search their database for free on their web site. The site also has information on programs to help consumers through the application process.
- RxAssist: An online database of drug company programs that provide free or affordable drugs and co-pay assistance.
- RxHope: A web-based resource you can search by medication to locate assistance programs. They also offer help with the application process.
- RxOutreach: A mail-order pharmacy for low-income people regardless of whether they have other insurance coverage.
Connecticut AIDS Drug Assistance Program
This program, also known as CADAP, helps people living with HIV and AIDS who may be uninsured or under-insured afford cost of life-prolonging medications.
To be eligible, applicants must:
- Be diagnosed with HIV or AIDS.
- Be a Connecticut resident.
- Have an income level at or below 400% of the Federal Poverty Level.
In addition to the above, individuals must not be a recipient of Medicaid. They must also apply for any health insurance coverage for which they may be eligible if they do not already have coverage.
Note that eligibility must be reviewed and renewed every six months to continue receiving benefits.
Download and complete the CADAP application to apply. Mail completed forms to:
Department of Social Services
Medical Operations Unit #4
55 Farmington Avenue
Hartford, CT 06105-3730
For more information on CADAP visit ct.gov.