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This demonstration program is designed to expand pharmacy coverage in the state in a fashion that furthers public, private, and individual fiscal responsibility. Individuals eligible for the program are Medicare beneficiaries based on age or disability with incomes at or below 200 percent of the Federal Poverty Level and not receiving full Medicaid benefits. This includes individuals eligible for Medicare Savings programs under Medicaid [which pay Medicare premiums, and in some cases, Medicare cost sharing expenses, e.g., Qualified Medicare Beneficiaries (QMBs) and Specified Low- income Medicare Beneficiaries (SLMBs)]. The program includes pharmacy benefits and coordination of primary care to complement and assist in the management of the enrollee's pharmacy services. The demonstration program is designed to assist individuals with pharmacy expenses, thereby maintaining better health and reducing the need for more costly medical care. Demonstrations can offer assistance by providing pharmaceutical products, assisting individuals with co-payments/deductibles for private pharmacy coverage, or providing wraparound pharmaceutical coverage to bring private sources of pharmacy coverage up to the level of the Pharmacy Plus benefit coverage. The demonstration program provides incentives for individuals with private coverage to keep that coverage rather than choose demonstration program coverage, and incentives for states to adopt competitive private sector approaches to provide more cost effective, modern prescription drug benefits in Medicaid. Features of Pharmacy Plus - Electronic application format with pop-up instructions for easy submission of essential program information,
- Structured series of check-off options for states to select,
- Simplified submission of data using an Excel template, and
- Sample model terms and conditions of approval.
Page Last Modified: 01/18/2006 4:03:00 PM
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