State of Nevada

 

Nevada Senior Rx

   

DISABILITY RX INDEX
DISABILITY RX
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State of Nevada

 

NEVADA DISABILITY RX - FAQ

  
What is Disability Rx?

A prescription subsidy for Nevadans with disabilities.

Funded with tobacco settlement and general fund monies.
The State provides assistance with Medicare Part D expenses for members who are eligible for Part D and a cost-sharing benefit for members who are not eligible for Part D.
  
What are the qualifications for Disability Rx?
Age 18 through 61
Nevada resident for at least one year at the time of application
If eligible for Medicare Part D, NOT also eligible for full federal subsidy with Part D expenses
Household income not over $27,292 for single persons
Household income not over $36,381 for married couples
  
How does the program work?
Qualifying persons receive an identification card.
Members who are not eligible for Medicare Part D present the card at a network pharmacy to purchase prescriptions or may order prescriptions through the program’s mail-order service.  Each option requires a co-payment.

Members who are enrolled in Medicare Part D plans but are in the coverage gap may present the card at their Part D pharmacy for payment. Disability Rx will pay the pharmacy claim as long as the prescription drug is on the formulary (preferred drug list) of the member’s Part D plan and all requirements for prior authorization and step therapies have been met. Due to technical issues, members who use their Part D plan's mail-order service may need to pay for the prescriptions and then request reimbursement from Disability Rx.

Members who are enrolled in Medicare Part D plans and are eligible for Disability Rx to pay part or all of their monthly premium need do nothing to receive this benefit.  Premium responsibility will be calculated through an electronic exchange of information with the member’s Part D plan and payment will be made directly to the plan.  Note that members should not authorize automatic premium deductions from their Social Security checks.  By law, Disability Rx cannot pay members directly for the premium subsidy.
  
How do I apply?

Applications may be requested from a Disability Rx representative by calling toll-free 1-866-303-6323 if outside the Reno-Carson City-Minden area, or call (775) 687-4210 if local. Applications can also be printed from the Internet at  http://dhhs.nv.gov/DisabilityRx.htm

Nevada Disability Rx
Department of Health and Human Services
3416 Goni Road, Suite D-132,
Carson City, NV 89706
(775) 687-4210, opt 7 Fax: (775) 687-0576
 

Representatives can also answer any questions you may have about completing the application or about the program in general.
  
Is there a waiting list?

Often, there is no waiting list for Nevada’s Disability Rx prescription subsidy program. When a waiting list is in effect, the persons on the waiting list with the lowest household income receive priority for enrollment. Please contact us to confirm whether a waiting list is currently in effect.
  
How and when will I be notified if I qualify?

The Department of Health and Human Services will notify all applicants of their eligibility status by letter within 45 days of receipt of the application.
  
If I apply and qualify now, do I have to reapply again next year?

No, you will not have to reapply again as long as you remain eligible.

You will, however, receive an Annual Eligibility Letter that requires you to verify that your situation has not changed and you believe you are still eligible for the program. You must reply to this letter to remain on the program.
  
Do I have to provide proof or eligibility at the time of application?

No, however, you may be asked to provide verification of your disability and/or proof of income, age, and residency after your application is received.
  
What are the co-payment requirements if I am NOT eligible for Medicare Part D?
$10 Generic
$25 Preferred Brand
$25 Non-Preferred Brand, if authorized as medically necessary
100% of the discounted rate for all other drugs
Further discounts are available through the mail-order option.
If you need information about the amount of the co-payment for a specific drug, call Catalyst Rx toll-free at 1-866-279-7383 or in Las Vegas call (702) 304-2970.  Identify yourself either as a Disability Rx member or applicant and give the customer service representative the name of the prescription drug, the strength, and the dosage.
  
Is there a limit to my annual benefit if I am NOT eligible for Medicare Part D?
Yes. The maximum benefit per year is $5,100. You reach the limit if you and the state together pay $5,100 toward your prescriptions. After that, no further prescriptions will be covered by the plan until January of the next year.
  
If I am eligible for Medicare Part D, do I have to use it?
Yes. If you are eligible for Medicare Parts A or B, then you are eligible for the federal prescription drug benefit that became available on January 1, 2006. Prior to implementation of Medicare Part D, the Nevada Legislature determined that Disability Rx should maximize these drug benefits. The result is that, if you are eligible for Part D, you must select and enroll in either a stand-alone prescription drug plan or a Medicare Advantage plan with prescription drug benefits. If you need help identifying a plan that meets your needs, call 1-800-Medicare (633-4227) and request a plan comparison.
  
If I am eligible for Medicare Part D, do I have to apply for the “extra help” from Medicare?

Yes. If you qualify for Medicare’s “extra help” (also known as federal low-income subsidy), you must apply for and use it.  To ask about current income and asset limits and to apply, call the State Health Insurance Assistance Program (SHIP) at 800-307-444 (or in the north 877-385-2345) OR Social Social Security Administration toll-free at 1-800-772-1213. The help could be very beneficial to you since Medicare may pay part or all of your monthly Part D premium, reduce or eliminate the annual Part D deductible, significantly reduce your co-payments and provide coverage during the Part D coverage gap. The amount of help you receive will depend on your income level.
  
What is the Medicare Part D coverage gap?
The Medicare Part D coverage gap is a temporary suspension of benefits. In 2012, when a Part D beneficiary AND his/her prescription drug plan have spent a combined total of $2930 on covered prescription medications, Part D coverage stops. The suspension of benefits continues until the beneficiary has spent another $4,700  on prescription medications. Disability Rx will cover all of an eligible member’s prescription drug costs during this gap as long as the medications are on the formulary (preferred drug list) of the member’s Part D plan and all requirements for prior authorization and step therapy are met. Disability Rx coverage will end and Medicare Part D catastrophic coverage will begin when the beneficiary leaves the coverage gap. At this time, the beneficiary pays only a small copayment of a few dollars for each prescription filled, with the Part D plan covering the remainder.

 

    

 

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Qualifications for Disability Rx
 
The maximum annual household income for singles is $27,292, and the maximum annual household income for married couples is $36,381.
 

Pharmacy Locator
 

Nevada Disability Rx
Department of Health and Human Services
3416 Goni Road, Suite D-132
Carson City, NV 89706
(775) 687-4210, opt 7 Fax: (775) 687-0576

Nevada Disability Rx Information Call:
687-4210, opt 7 in the Reno-Carson City-Gardnerville area, or if outside these areas call toll-free
1-866-303-6323

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