SenioRx program offers help with prescriptions

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Carl and Willetta Goeke are hoping a new Missouri program will give them some financial relief on the costs of their prescription medication.|ret||ret||tab|

"We're anxious to find out about the actual benefits," said Carl, primarily because the Goekes are looking for help in paying the $2,000 annual cost of the medication needed to treat Willetta's heart condition.|ret||ret||tab|

The Springfield couple is among the more than 8,000 people who have so far applied for what is titled the "Missouri SenioRx Program," designed to subsidize low-income people 65 and older for the expense of their prescription drugs not covered by other insurance.|ret||ret||tab|

The program, established by the state legislature in a special session last fall, has an enrollment deadline of May 30 and is scheduled to start paying benefits to as many as 55,000 qualified applicants starting July 1.|ret||ret||tab|

No data is available on the number of people from the Springfield area who have applied. But Diana Richards, information and assistance director at the Southwest Missouri Office on Aging in Springfield, said enrollment interest has been steady.|ret||ret||tab|

"We have been helping 30 to 40 people a day" since enrollment began April 1, she said.|ret||ret||tab|

Kathy Iman of KJI Enterprises in Nixa, one of the 15 members on the Missouri SenioRx Commission that oversees the program, said, "I was really im-pressed how hard people in state government worked to get a project of this magnitude put together so quickly.|ret||ret||tab|

"I'm hopeful a lot of people who need help will enroll. I think it will really do some good for people."|ret||ret||tab|

In light of the state's continuing budget problems that arose a year ago, there was some concern this spring that revenue might not be sufficient to cover the state's projected $75 million share of the senior drug subsidy program for the coming year.|ret||ret||tab|

"I personally called a lot of local legislators to help get this through," Iman said. "We have already really cut this to the bone for the first year."|ret||ret||tab|

The creation of the SenioRx program was prompted by the unanticipated cost of a drug tax credit for seniors established by the state in 1999. That policy provided for a flat $200 annual drug expense tax credit for seniors 65 and older with less than $15,000 income, but it also offered a sliding scale of reduced benefit for those with higher incomes.|ret||ret||tab|

However, the legislature didn't expect that the Department of Revenue, in administering the program, would write in the credit, even if an eligible taxpayer didn't apply on the income tax return. As a result, it cost the state more than $80 million on an annual basis and caused the legislature to look for an alternative.|ret||ret||tab|

"Most of all, we found that seniors needed real-time assistance, which was the most important reason for moving away from the tax credit," said Rebecca Mankin, executive director of the SenioRx program.|ret||ret||tab|

Also, she said, the need was apparent because Medicare doesn't cover drug prescriptions that are rising dramatically in cost, and many low-income seniors "are very proud" and don't want help from Medicaid.|ret||ret||tab|

The average senior citizen spends about $1,200 a year on prescription medication, Mankin said. "In our program, the lower the income, the higher the cost, because we project $2,000 to $2,200 for our participants," she said. "That's nearly 10 percent on the $23,000 household income (eligibility limit) for couples."|ret||ret||tab|

Without the money for medications, many poorer people ration their drugs, ration their food, turn off air conditioning and do other things to make ends meet, but which threaten their health further, Mankin said.|ret||ret||tab|

The plan ultimately adopted in the special session of the General Assembly repeals the $200 tax credit and specified help for low-income seniors who don't have insurance for medications. But it is by no means a free ride and more complicated than a simple tax credit.|ret||ret||tab|

First, it repealed the tax credit and limited benefits to people 65 and older with household incomes of no more than $23,000 for a married couple and $17,000 for individuals.|ret||ret||tab|

People on Medicaid, which covers prescriptions, are not eligible, and the legislation also expanded the state's Medicaid plan to take in some more seniors, Mankin said. |ret||ret||tab|

If people have other insurance plans that cover medications, they also would be ineligible, but coverage can be coordinated for recipients of Medicare supplementals, she said.|ret||ret||tab|

"We are a payer of last resort," she said.|ret||ret||tab|

Those who benefit from the program also have to share in the overall cost. There is an enrollment fee of $25 or $35 a year, along with a deductible of $250 or $500, depending on the income category. Additionally, there is a 40 percent co-pay per prescription on generic medications, and the differential cost if the recipient gets a higher-priced brand name. The annual total benefit limit is $5,000.|ret||ret||tab|

On the pharmacy side, state officials also designed a plan attractive enough that they believed it would assure high participation by the state's 1,500 pharmacy outlets. |ret||ret||tab|

"The legislation gave them (drug manufacturers and retailers) a good rate," Mankin said.|ret||ret||tab|

Under the plan, manufacturers must pay 15 percent rebates to help fund the program. Retailers are required to provide discounts, but also get a dispensing fee of $4.09 on each prescription sold.|ret||ret||tab|

"We're absolutely going to participate," said Melody Miller, director of pharmacy operations for Ramey-Price Cutter stores. "There's a severe need for the senior population that falls between the gaps. Prices are so out of control."|ret||ret||tab|

Officials estimate that 55,000 people will participate in the first year of the drug prescription subsidy program, director Mankin said.|ret||ret||tab|

The state's estimated $75 million share of the cost in the first year will be paid out of Missouri's tobacco litigation settlement funds. Program participants will supply $2 million to $3 million through enrollment fees, and rebates from drug manufacturers will contribute $6 million to $7 million, officials estimate.|ret||ret||tab|

Enrollment and claims processing is being handled by a company called ACS State Health Care out of Atlanta, which won the state contract bid for that work at a price of $4.1 million.|ret||ret||tab|

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