LIS – Low Income Subsidy – Extra Help

What help can I receive if I can’t afford all my Prescriptions?
What if I have too many assets or higher income?

Low Income Subsidy – Extra Help

The Low-Income Subsidy (LIS) program/extra helps pay for a portion of Part D prescription drug plan costs, including Part D premiums, deductibles and copayments.

Depending on your income and assets, you may qualify for the full subsidy or a partial subsidy. All beneficiaries who qualify for the LIS program are permitted to change Part D plans once a month at anytime during the year. ^{CA Health Care Advocates}     The full Low-Income Subsidy (LIS) program covers the premium and deductible of benchmark plans, that meet the minimum standards.  This means you do not pay a premium or deductible if you receive the full LIS benefit and enroll in a benchmark plan. You are, however, still responsible for copayments of $3.70 to $9.20  for each covered prescription. ^{CA Health Care Advocates}

Here’s #MoreAassistance
Even if you have high assets & Income
Beyond Part D Rx

Assistance Programs from the Manufacturer
and Government Programs

Medication Assistance Tool.org  the Medicine Assistance Tool, matches patients like you with resources and cost-sharing programs that may help lower your out-of-pocket costs, whether or not you have insurance.  This tool includes Merck

CA Health Care Advocates – Resources for Rx Drug Savings

Pan  Foundation.org
The Patient Access Network (PAN) Foundation is  dedicated to helping federally and commercially insured people living with life-threatening, chronic and rare diseases with the out-of-pocket costs for their prescribed medications. Partnering with generous donors, healthcare providers and pharmacies, PAN provides the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life.

Pharmaceutical Assistance Program

Benefits Checkup.org

National Patient Advocate Foundation

National Organization for Rare Disorders

California Prescription Drug Discount Program
At Medi-Cal participating pharmacies, you can get prescription drugs at the Medi-Cal rate plus a $0.15 processing fee. This rate may be lower than the Part D rate. Payments may not apply toward your Part D cost-sharing. This program should not be used as a substitute for Medicare Part D. To receive benefits, show your Medicare card at Medi-Cal participating pharmacies   ^{SB 393 2000}

6 Hints to get help with Rx costs on Medicare.gov

california rx card.com

Glaxo Smith Kline Rx Assistance

pfizer rx pathways.com    Find Assistance That’s Right for You    Pfizer RxPathways connects eligible patients to a range of assistance programs that offer insurance support, co-pay help,^* and medicines for free or at a savings.^†  Enter the name of the medicine you’ve been prescribed. You can search one medicine at a time. Then answer a few questions to see which available program(s) may be right for you.

Humira

MS Multiple Sclerosis

Financial Assistance Programs

• The Assistance Fund 877-245-4412
• GoodDays 877-968-7233
• HealthWell Foundation 800-675-8416 *Medicare only
• copaxone.com/shared-solutions

RxAssist.org    RxAssist can help you learn about ways to use pharmaceutical company programs and other resources to help reduce your medication costs. Look at our database and frequently asked questions to get started.

Coupons 

If one has Part D Rx, the manufacturers cannot help out with coupons.  One might consider dropping Part D or if you have Medicare Advantage Plan, finding one that doesn’t include Part D.  We CANNOT advise you to do this. It’s beyond our pay grade and we are mandated to tell you about the penalty if you don’t purchase Part D.  Scroll down for hints from one of our wholesalers on using coupons and not using your Part D Rx plan.

The intention for coupons is to steer patients away from cheaper generic alternatives and toward the brands that they produce. Experts estimate that brand drug manufacturers are spending between $3 billion and $6 billion annually on coupon programs. Anti-Kick Back and all. ^{HHS Report} Mfg safeguards might not prevent coupons for Part D Rx Legally, the use of drug co-pay cards and coupons by individuals with government funded health care and prescription drug benefits, such as Medicare and Medicaid, is prohibited by the federal anti-kickback statute.

(2) Whoever knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person—

(A) to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal health care program, or SSA.gov

Here’s some hints from our wholesaler…

Coupons are allowed to be used in Medicare, but it is tricky. When a client uses a coupon, or a GoodRX or even the pharmacies billing costs (which are sometimes cheaper than the plan copay) the drug doesn’t get run through Medicare, it becomes a cash pay situation and it doesn’t go against the Medicare deductibles, donut hole,  etc.   So that is the negative.

I have many clients that have purchased drugs directly from the pharmacy to get a lower cost, and some that have used Good RX or even just googled their drugs and bought them online at a cheaper cost.

There are certain things that are much cheaper online, Progesterone is a big one that my female clients find cheaper online..

So, if the pharmacy will work with the client to help them find the lowest cost, there are alternatives for our Medicare clients. Not all pharmacies will do this however, so it is good to do some research on more expensive drugs to find alternative solutions.