Outside Section 8

Medicare Part D and Prescription Advantage

SECTION 8.   Section 39 of chapter 19A of the General Laws, as so appearing, is hereby amended by inserting after subsection (s) the following 3 subsections:-

          (t) Cost sharing required of enrollees in the form of co-payments, premiums, and deductibles, or any combination of these forms, shall be adjusted by the department to reflect price trends for outpatient prescription drugs, as determined by the secretary. In addition to the eligibility requirements set forth in this section, to be considered eligible for the program, individuals who receive Medicare and are applying for, or are then enrolled in, the program shall also be enrolled in a Medicare prescription drug plan, a Medicare Advantage prescription drug plan, or in a plan which provides creditable prescription drug coverage as defined by section 104 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, in this section called MMA, and which provides coverage of the cost of prescription drugs actuarially equal to or better than that provided by Medicare Part D, in this section called a creditable coverage plan.

          (u) In addition to the eligibility requirements set forth in this section, to be considered eligible for the program, individuals who receive Medicare and are applying for, or are then enrolled in, the program, who may qualify for the low-income subsidy provided under MMA Subpart P - Premiums and cost-sharing subsidies for low-income individuals, shall apply for those subsidies. To the extent permitted by MMA and regulations adopted under it, and all other applicable federal law, the program may apply on behalf of a member for enrollment into a Medicare prescription drug plan or for the low-income subsidy provided under MMA and may receive information about the member's eligibility and enrollment status necessary for the operation of the program.

          (v) For enrollees who qualify for enrollment in a Medicare Part D plan, the program shall provide a supplemental source of financial assistance for prescription drug costs, in this section called supplemental assistance in lieu of the catastrophic prescription drug coverage provided under this section. The program shall provide supplemental assistance for premiums, deductibles, payments, and co-payments required by a Medicare prescription drug plan or Medicare Advantage prescription drug plan, and shall provide supplemental assistance for deductibles, payments and co-payments required by a creditable coverage plan. The department may take steps for the coordination of these benefits. The department shall establish the amount of the supplemental assistance it will provide enrollees based on a sliding income scale and the coverage provided by the enrollees' Medicare prescription drug plan, Medicare Advantage prescription drug plan, or creditable coverage plan. In addition to the eligibility requirements set forth in this section, to be considered eligible for the program, an individual must have a household income of less than 500 per cent of the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. section 9902(2). Residents of the commonwealth who are not eligible for Medicare will continue to be eligible for the program under this section.
 
 

Summary:
This section is intended to maintain the fiscal viability of the Prescription Advantage Program, the state prescription drug insurance program. Prescription Advantage is used in conjunction with the federal prescription drug program, Medicare Part D, to ensure that income eligible Massachusetts residents have prescription insurance. This section allows the Department of Elder Affairs to adjust cost sharing guidelines to reflect cost changes that are a result of pricing adjustments made by pharmaceutical suppliers.