SHINE On:

Prescription Advantage Lives! Be Sure to Get Your Benefits


By Sheila Curtis
Even though the Medicare Part D program has been in effect for a year, we are still finding that those who have the state’s drug program, Prescription Advantage, as their secondary drug coverage are not receiving the benefits to which they are entitled.

Many thought that Prescription Advantage went away last January but that is not true! Prescription Advantage is still around and acts as secondary or supplementary insurance to your Medicare Part D plan. Depending on your income category, Prescription Advantage may pay all or part of your Part D premium, it will put a cap on your co-pays and it helps with the deductible and the donut-hole gap.

You need to call Prescription Advantage at 1-800-243-4636 and ask:

The most that Prescription Advantage members should be paying for a 30-day supply is $12 for a generic drug and $30 for a brand name drug even in the gap. (This does not pertain to those who are in the highest income category and pay Prescription Advantage a $200 enrollment fee.) Make sure the pharmacist is billing to both plans every time. This is the only way that Prescription Advantage can keep track of your out-of-pocket expenses.

If you find you have been paying more than the Prescription Advantage co-pay, you can request a paper claim form from them and get reimbursed. You will need to ask the pharmacist for a printout of the drugs you had purchased from January 2006 to the present time and then send that in to Prescription Advantage along with the claim form.

There also is a problem if you’re using your Part D plan’s mail order. A lot of the mail order pharmacies are not set up to do secondary billing. You will need to call Prescription Advantage to get reimbursed. Prescription Advantage also acts as secondary insurance to those of you who have “creditable” drug coverage with a retirement or Medigap (supplemental) plan.

If you would like more information on how Prescription Advantage works or would like to be notified the next time Prescription Advantage has an open enrollment please call 1-800-334-9999.

(Ms. Curtis is Regional Director of SHINE, Serving the Health Information Needs of Elders, a division of the Massachusetts Executive Office of Elder Affairs.).

HOPE Project Offers Help To Needy In Search Of Health Care Insurance


Having trouble obtaining health insurance? Here’s one case where hope is not just a wish but an opportunity.
The HOPE Project, a program of the Community Action Committee of Cape Cod & Islands, Inc., is there to help residents with applications for MassHealth as well as the new Commonwealth Care Health Insurance Program.

HOPE connects eligible Massachusetts residents with approved health insurance plans and also may help them pay for their coverage. It is designed for citizens and documented immigrants who are not able to obtain this protection through MassHealth or their employers.

Candidates’ income must be less than 300 percent of the Federal Poverty Guidelines, about $29,000 annually for a single person, $39,000 for a family of two.

To be eligible for Commonwealth Care an applicant must be:

More information about MassHealth and Commonwealth Care can be obtained by contacting or visiting outreach educators at the HOPE Project at 115 Enterprise Road in Hyannis, 1-800-845-1999, extensions 168, 173 or 174. Assistance also is available at other locations around the Cape and possibly soon through the VNA of Cape Cod’s Mobile Health Link van.

County Unveils Rx Discount Card For All Residents
With Average 20 Percent Savings Off Retail Price

In cooperation with the National Association of Counties (NACo), Barnstable County has launched a discount card program to help consumers cope with the high price of prescription drugs.

 The county is making free prescription drug discount cards available under a NACo-sponsored program that offers average savings of 20 percent off the retail price of commonly prescribed drugs. The cards may be used by all county residents, regardless of age, income, or existing health coverage, at many Cape Cod pharmacies, including CVS, Walgreen’s Stop & Shop, Wal-mart, and Brooks. A national network of more than 57,000 participating retail pharmacies also honors the NACo prescription discount card.

Cape Cod residents need only present the NACo prescription discount card at a participating pharmacy. There is no enrollment form, no membership fee, and no restrictions or limits on frequency of use. Cardholders and their family members may use the card any time their prescriptions are not covered by insurance. Residents do not have to be Medicare beneficiaries to be eligible for this program.

In addition to making the NACo prescription discount cards available at Barnstable County offices off Route 6A in Barnstable Village, the county has distributed the cards to these human services agencies: Upper Cape Family Network, Independence House, Kids and Teens Behavioral Health Assessment Center, Bridges Associates, Family Continuity, Children’s Cove, 4-H, Cape Cod Children’s Place, Nauset Together We Can, Big Brothers/Big Sisters, Cape Cod Neighborhood Support Coalition, Cape Cod Child Development, The Cape Cod Foundation, Barnstable County Sheriff’s Office, South Bay Mental Health Center, Town of Barnstable Youth Commission, Community Action Committee of Cape Cod and the Islands, Barnstable Housing Authority, Adult Collaborative of Cape Cod Education and Support, Duffy Health Center, Cape Cod Medical Reserve Corps, and Community Care For Depression.

The county also is in the process of distributing the cards through all Cape Cod town boards of health.
There is no cost to Barnstable County taxpayers for NACo to make these cards available to county residents. The discount card program is administered by Caremark Rx, Inc.

Barnstable County is the second county in the state to participate in the NACo prescription drug discount card program. Dukes County offers the NACo program to Martha’s Vineyard residents.

Barnstable County residents can call toll free 1-877- 321-2652 or visit the Web site naco.advancerx.com for assistance.