What
is Senior Rx? |
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A prescription
subsidy for seniors passed during the 1999 Legislative
Session. |
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Funded with
tobacco settlement and general fund monies. |
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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. |
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What
are the qualifications for Senior Rx? |
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Age 62 or older |
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Nevada resident
for at least one year at the time of application |
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If
eligible for Medicare Part D, NOT also eligible for full
federal subsidy with Part D expenses |
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Household income
not over $24,561 for single persons |
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Household income not over $32,742 for married couples |
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How
does the program work? |
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Qualifying
seniors receive an identification card |
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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. |
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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. Senior 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 Senior Rx. |
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Members who are enrolled in Medicare Part D plans and are
eligible for Senior 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, Senior Rx cannot pay members
directly for the premium subsidy. |
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How
do I apply? |
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Applications
may be requested from a Senior Rx representative by
calling toll-free 1-866-303-6323 if outside the Reno-Carson
City-Minden area, or call 687-7555 if local. Applications can
also be printed from the Internet at
http://dhhs.nv.gov/SeniorRx.htm |
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Representatives
can also answer any questions you may have about
completing the application or about the program in
general. |
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Is
there a waiting list? |
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Not at this time. |
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How
and when will I be notified if I qualify? |
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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. |
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If I apply and
qualify now, do I have to reapply again next year? |
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No, you will not
have to reapply again as long as you remain eligible. |
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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. |
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Do
I have to provide proof of eligibility at the time of
application? |
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No,
however, you may be asked to provide proof of income, age,
and residency after your application is received. |
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What are the
co-payment requirements if I am NOT eligible for Medicare
Part D? |
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$10 Generic |
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$25 Preferred
Brand |
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$25
Non-Preferred Brand, if authorized as medically necessary |
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100% of the
discounted rate for all other drugs |
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Further
discounts are available through the mail-order option |
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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 Senior Rx member or applicant and give
the customer service representative the name of the
prescription drug, the strength, and the dosage. |
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Is there a limit
to my annual benefit if I am NOT eligible for
Medicare Part D? |
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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. |
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If I am
eligible for Medicare Part D, do I have to use it? |
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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
Senior 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. |
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If I am
eligible for Medicare Part D, do I have to apply for the
“extra help” from Medicare? |
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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 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. |
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What is the
Medicare Part D coverage gap? |
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The Medicare Part D coverage gap is a temporary suspension
of benefits. In 2007, when a Part D beneficiary AND his/her
prescription drug plan have spent a combined total of $2,400
on covered prescription medications, Part D coverage stops.
The suspension of benefits continues until the beneficiary
has spent another $3,021 on prescription medications. Senior
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. Senior Rx coverage will end and Medicare
Part D catastrophic coverage will begin when the $3,021
target is reached. |
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