SenioRx program lags behind in enrollment

Missouri's senior citizens aren't taking advantage of the SenioRx prescription drug coverage program as much as state officials had hoped.

Laurie Hines, executive director of the SenioRx drug benefit program created by special session legislation in 2001 and implemented in July 2002, said that enrollment numbers declined for the 2003 program year.

"The legislation requires each member to re-enroll each year so there's sort of a duplicate count, to some extent," Hines said. "But the first year, we had about 21,000 people in. We just started the second program year (July 1) and unfortunately our enrollment declined which we are very disappointed in to probably around 19,000."

Enrollment for the program, which serves eligible seniors age 65 and up, is open from Jan. 1 to Feb. 28 each year.

"I think the first year was pretty rough. I think we got some bad press. We had some drug manufacturers, particularly the generic ones, that joined the program and left," Hines said. The average participant is 78 years old, and the majority are women, she said.

"I think that seniors in this age range they're very skeptical of government and they don't typically access government services. And I think there might be a stereotype that this is welfare. It clearly isn't," she said.

Hines also believes that the January-February annual enrollment period is a detriment for older people because of winter weather.

Eligibility and benefits

Income guidelines allow $23,000 in household income for a married couple and $17,000 for an individual. Most eligible seniors within those limits can participate in SenioRx even if they have other insurance.

"Essentially as long as it's not as generous as our program (then they can participate). And a lot of the coverage that seniors have right now is not," Hines said.

To enroll, participants must pay an annual fee of $25 or $35, depending on income, and the annual deductible, also determined by income, is $250 or $500. Once that deductible is met, the program pays 60 percent of the cost of eligible medicines, up to $5,000 per year.

Recent changes

In August, the state announced increased drug coverage that brought many of the generic drug programs back into the program. With the changes, it is projected that seniors in the plan will save an average of $808 per year. In the program's first year, seniors had an average annual savings of $527.

The Missouri Legislature reduced the amount generic drug companies have to pay the state from a 15 percent rebate to an 11 percent rebate, based on the amount of each company's drugs used through the program each quarter.

"A lot of the generics said We're not going to participate any longer,' because our statute said a 15 percent rebate or kickback (had to come) from everybody brands and generic. And generics make a very good argument that their profit margins are much lower than brands', and it is. They're definitely much cheaper," Hines said. Brand-name drug manufacturers must continue to pay 15 percent rebates.

There are now about 150 drug companies participating in the plan.

Pharmacy support

Hines is working hard to increase pharmacy support of the program, although she said that every retail pharmacy in the state about 1,100 participates in the program. Some licensed pharmacies, such as those at hospitals, don't do retail sales and are not included in the program.

She said pharmacies haven't been as supportive as they could have been, but that goes back to the beginning of SenioRx.

"We sort of left them out as a stakeholder group. Or not left them out, but we probably didn't engage them as much as we should," she said. Pharmacy participation in SenioRx is voluntary.

"We pay them a very good reimbursement rate on drugs. We pay them a $4.09 dispensing fee, so we think we're very competitive," she said. The reimbursement rate for drugs varies by drug.

Future plans

Rebate funds are expected to increase as the program grows, and eventually, Hines would like to get rid of the annual enrollment fees.

"It's a nightmare to collect those checks and cash them," she said.

Plans for increasing enrollment include having more of a targeted outreach to find seniors in the income range, and who have enough drug costs to make this valuable.

What's difficult, Hines said, is that the state has tried just about everything to get the word out. Plans now are to hire a public relations firm to get the message out.

"We continue to hear (seniors) can't afford food or utilities because they can't pay for drugs. And we're thinking, Here the state of Missouri has stepped up two years ago and we only have 19,000 people signed up.' It just doesn't make sense."