American Indians and Alaska Native (AI/AN) Medicare beneficiaries who utilize Indian health program pharmacies can now begin taking advantage of two specially endorsed Medicare-approved drug discount cards and the $600 credit tailored for their needs according to an announcement today by the Centers for Medicare & Medicaid Services (CMS) and the Indian Health Service (IHS).
The two special drug cards for Indian health program pharmacies are Criterion Advantage and Pharmacy Care Alliance. The AI/AN Medicare beneficiaries who enroll in these drug cards can use their card at other pharmacies. Both cards have large national networks of pharmacies in addition to the Indian health program pharmacies. The AI/ANs can also choose from any of the other drug cards already participating in the program. More information about the drug discount cards as well as other drug cards can be obtained by calling 1-800-MEDICARE (633-4227) or by going to the Medicare Website at www.medicare.gov.
"These two specially endorsed drug cards are tailored to meet the needs of those accustomed to using special pharmacies," said Mark B. McClellan, M.D., Ph.D., administrator of CMS. "These pharmacies may be the only drug stores serving remote areas where they are needed the most." Providing drug cards through AI/AN pharmacies used by many American Indians and Alaska Natives furthers the Bush Administration goal of providing more affordable, up to date drug coverage for all Medicare beneficiaries. "We want to keep people healthy, prevent illnesses and reduce health disparities, and these special Medicare drug cards are another step in achieving that goal." said Dr. McClellan.
Low-income AI/AN Medicare beneficiaries may also qualify for the $600 credit for this year and another $600 for next year. The $600 credit is available to AI/AN Medicare beneficiaries who do not have other prescription drug coverage, and whose annual income is below 135 percent of the federal poverty limit, which in 2004 is no more than $12,569 for individuals and $16,862 for married couples (in Alaska, no more than $15,701 for individuals and $21,074 for married couples). Individuals who qualify for the credit will not have to pay the annual enrollment fee for the discount card. The $600 credit can be used with any Medicare-approved drug discount card and with any pharmacy in that card's network, including the Indian health program pharmacies.
"These special drug discount cards will not only reduce the cost of drugs for many American Indians and Alaska Natives," stated IHS Director Dr. Charles W. Grim, "but will also enable Indian health program pharmacies to bill against the $600 credit for drugs dispensed to beneficiaries, providing a valuable source of third-party collections to the Indian health system. These funds can then be used to provide more health care services to American Indian and Alaska Native people."
Further information on the drug cards can be found at www.criterionadvantage.com and www.pcacard.com. General information on the Medicare program can be found at www.medicare.gov.
New Special Medicare-Approved Drug Discount Cards for People who
use Pharmacies Operated by Indian Health Programs
You may have already heard that in 2004 and 2005, people with Medicare
can sign up to get a Medicare approved drug discount card, and that
those with low incomes can also sign up for a $600 credit available
for each year. The drug discount card and the $600 credit can help
you save money on your prescriptions. You can choose from any of
the Medicare-approved drug discount cards in the area where you
live. There are also two special cards available if you get your
prescriptions through pharmacies operated by an Indian health program,
that is, the Indian Health Service, a Tribe, a Tribal organization,
or an urban Indian organization.
You qualify for any Medicare-approved drug discount card if:
- You have Medicare AND
- You do not have outpatient prescription drug coverage from Medicaid
You qualify for the $600 credit and will not have to pay the enrollment
fee if:
- Your monthly income in 2004 is no more than $1,048 for a single person or no more than $1,406 for a married couple. (If you live in Alaska, your monthly income limits are no more than $1,309 if you are single or no more than $1, 757 if you are married.) AND
- You do not receive outpatient prescription drug coverage from certain other sources such as TRICARE, group health insurance, or Federal Health Benefits Plans (FEHBP)
Special cards for use at pharmacies operated by Indian health programs
If you meet all of the conditions above, and you obtain prescriptions
from a pharmacy operated by an Indian health program, you may want
to consider one of two special Medicare drug cards specially designed
for use at I/T/U pharmacies:
| Card Name | Card Sponsor | Telephone Number |
Criterion Advantage |
Computer Sciences Corporation | 1-877-646-5309 |
| Pharmacy Care Alliance (Option 1) | Pharmacy Care Alliance |
1-800-722-7015 |
You can use these special drug cards and the $600 credit at any retail or mail order pharmacy in the card sponsor's network. However, if you use one of these cards at an I/T/U pharmacy, your whole community benefits. The I/T/U pharmacy can use your $600 credit from Medicare to pay for the prescriptions it provides you, so that it has more money to provide other services in your community. Check with your local I/T/U pharmacy to see if it accepts either or both cards. Enrolling in any drug card is your choice. To get a Medicare-approved drug discount card and the $600 credit:
- Call the company offering one of these cards and ask for an enrollment form, OR speak with your local I/T/U pharmacist or patient benefits coordinator about cards for use at I/T/U pharmacies,
- Fill out the enrollment form for the card and $600 credit, and
- Send the signed enrollment form to the card sponsor.
Once your enrollment form has been processed and accepted, the card
sponsor will send you its Medicare approved drug discount card.
If you already have a Medicare-approved drug discount card, and
you would like to change to a card that can be used in I/T/U pharmacies,
contact your current card sponsor or your local patient benefits
coordinator for information on how to switch. You can also get enrollment
forms and information about any Medicare-approved drug discount
card by calling 1-800-MEDICARE. TTY users should call 1-877-486-2048.
Produced by the Centers for Medicare & Medicaid Services, October
2004
Questions about the Medicare-Approved Drug
Discount Card and $600 credit for I/T/U Pharmacies
Why should an I/T/U pharmacy accept Medicare-approved drug
discount cards?
If American Indians or Alaska Natives with Medicare use the $600
credit on their drug card at a pharmacy operated by an Indian health
program, that is, as the Indian Health Service, a Tribe, a Tribal
organization, or an urban Indian organization (I/T/U), the pharmacy
will be reimbursed for the prescription. This means that the I/T/U
pharmacy will have more money to provide other services to the people
it serves.
Who figures out how much pharmacies are reimbursed for
prescriptions bought with a Medicare-approved drug discount card?
The drug card sponsors and I/T/U pharmacies will agree on a reimbursement
amount. The decision must meet all Federal laws.
Will CMS provide sample drug card sponsor contract language
to I/T/U pharmacies and drug card sponsors?
Indian Health Service (IHS) has negotiated national contracts with
the drug card sponsors for all pharmacies directly administered
by the IHS. Sample contract language has been developed for pharmacies
administered by Tribes, Tribal Organizations and Urban programs.
These pharmacies may use this sample contract language or propose
contract language from previous or current pharmaceutical services
contracts to drug card sponsors.
Do I/T/U pharmacies have to join the Medicare-approved
drug discount cards specially designed for use in I/T/U pharmacies?
No. Sponsors will give I/T/U pharmacies in their service area an
opportunity to join, but participation is voluntary. The Indian
Health Service has signed national contracts to include all of its
pharmacies in the networks of both special cards.
How do I/T/U pharmacies join the networks of these specially
designed Medicare-approved drug discount cards?
There are two sponsors that have been approved to offer these types
of cards: Pharmacy Care Alliance (PCA) and Computer Sciences Corporation
(CSC). They will work through the Indian Health Service to contact
I/T/U pharmacies. Sponsors of these special cards will give all
I/T/U pharmacies in their service area an opportunity to join, but
participation is voluntary.
See attached ITU Benefits Question and Answer.