State Government Programs (Prescription Drugs at Low Cost)

Various state governments have programs to assist individuals with financial difficulties in obtaining prescription drugs. These programs are needed because many people make too much money to qualify for Medicaid. These programs are different, however, from the programs that most states have to aid individuals with specific diseases or conditions that can be very expensive to manage, such as AIDS, cancer, cardiovascular disease, and diabetes.

Presently, only about half of all the states have some type of program specifically designed to aid individuals with prescription drug costs. The eligibility criteria and services provided differ from state to state and from program to program. Appendix A summarizes the state assistance programs for those states that presently offer one. States are constantly adding new programs or modifying existing ones. To keep up with all the changes and to find out the specifics for the state in which you live, log on to the web site of the National Conference of State Legislatures at www.ncsl.org/programs/health/drugaid.htm.

These programs are usually designed for seniors (persons age 65 and older) on Medicare. However, certain individuals, including those with disabilities, such as blindness, can join. Eligibility is usually based on income and this varies from state to state. These programs are usually very comprehensive, that is, they cover a lot of prescriptions.

All of the programs have some form of cost sharing, which means that the patient pays for some of the cost of the medications. These costs come in various forms like copays and deductibles. A deductible is the amount you have to spend before the program starts helping you. So if, for example, you have a deductible of $200, you will have to spend $200 on medication in that year before you can start using the program. Some programs also have enrollment fees and some have premiums, which are amounts you pay to be in the program. Premiums are similar to what you pay to have insurance. So, in those states that have premiums, you will be charged a certain amount that you can pay over time just like you can with your car insurance.

To use the state prescription assistance program:

1. Obtain the phone number for your state’s program (see appendix A for the number).
2. Get an application sent to you.
3. Enroll in the program and obtain a card.
4. Present the card at the pharmacy when filling a prescription.
5. Get the drug with a copay or at a discount.