dual-eligible patients (medicaid & medicare part D) who need part B drugs (eg Neoral)

Thread view:

Enable EMail Alerts

Start New Thread

Thread rating:

theltimf - 19 Jan 2006 02:20 GMT

I work for an independent pharmacy where we have just 1 patient
(currently) who is dual eligiable for medicaid & medicare part D. Last
year his anti-rejection meds (Neoral) were 100% covered by medicaid.
This year, medicaid considers Neoral a part B drug; thus, theres a 20%
co-insurance "co-pay" of approximately $77.00 per month, which his part
D insurer says he must may. Although he is medicaid enrolled also, the
state is refusing to pick up the $77.00 charge, since this is part B,
not part D. My state will pick up the tab for other drugs excluded by
part D, such as cough & cold, etc., but for some reason (PA) rejects
the part B co-insurance! Has anyone else had this problem? The pt
cannot afford the $77.00/mo, and there are other rxs that will affect
him also. Who should pay the $77.00? And, how do you bill it?

Reply to this Message

Dr. Wayne Simon - 20 Jan 2006 06:06 GMT

>I work for an independent pharmacy where we have just 1 patient
> (currently) who is dual eligiable for medicaid & medicare part D. Last
[quoted text clipped - 8 lines]
> cannot afford the $77.00/mo, and there are other rxs that will affect
> him also. Who should pay the $77.00? And, how do you bill it?

Interesting. If the patient goes into acute rejection it will cost the
state a lot more than 77 dollars, and could cost the patient his life.

Reply to this Message

Pumbaa - 20 Jan 2006 13:38 GMT

<Snip>

> Interesting. If the patient goes into acute rejection it will cost the
> state a lot more than 77 dollars, and could cost the patient his life.

Its interesting to know that the U.S.A.'s capitalist health care system
can be just as screwed-up and illogical as anything from Canada or Europe.
It looks like the patient should be able to choose himself if he wants to
use EITHER Medicaid or use Medicare Part D for his drugs. Its seems many
people have found out the hard way that for drug coverage the new Medicare
Part D is worse than Medicaid.

Reply to this Message