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Budget Summary FY2010

Outside Section 122
Data Current as of:  1/26/2010




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Prescription Advantage

SECTION 122.   Notwithstanding any general or special law to the contrary, and in order to maintain the fiscal viability of the subsidized catastrophic prescription drug insurance program, hereinafter referred to as the prescription advantage program, authorized by section 39 of chapter 19A of the General Laws, cost-sharing required of enrollees in the form of co-payments, premiums and deductibles, or any combination thereof, may be adjusted by the executive office of elder affairs to reflect price trends for outpatient prescription drugs, as determined by the secretary of elder affairs. In addition to the eligibility requirements set forth in said section 39 of said chapter 19A, to be considered eligible for the prescription advantage program, individuals who receive Medicare and are applying for, or are then enrolled in, the prescription advantage 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 in section 104 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Pub. L. No. 108-173, hereinafter referred to as "MMA," and which provides coverage of the cost of prescription drugs actuarially equal to or better than that provided by Medicare Part D, hereinafter referred to as a "creditable coverage" plan. In addition to the eligibility requirements set forth in said section 39 of said chapter 19A, to be considered eligible for the prescription advantage program, individuals who receive Medicare and are applying for or are enrolled in the prescription advantage program shall apply for the low-income subsidy provided under MMA Subpart P: Premium and Cost-Sharing Subsidies for Low-income Individuals, if such individuals qualify for such subsidy. To the extent permitted by MMA, regulations promulgated thereunder, and all other applicable federal law, the prescription advantage 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 prescription advantage program. For enrollees who qualify for enrollment in a Medicare Part D plan, the prescription advantage program shall provide a supplemental source of financial assistance for prescription drug costs, hereinafter referred to as "supplemental assistance," in lieu of the catastrophic prescription drug coverage provided pursuant to said section 39 of said chapter 19A. The prescription advantage program shall provide supplemental assistance to eligible individuals enrolled in a Medicare prescription drug plan, Medicare Advantage prescription drug plan, or a plan offering creditable coverage, and may do so to assist with premiums, deductibles, payments or co-payments that are required by such plans. The executive office shall establish the amount of the supplemental assistance to be provided to 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 said section 39 of said chapter 19A, to be considered eligible for the prescription advantage program, an individual shall have a household income of less than 500 per cent of the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services pursuant to 42 U.S.C. 9902(2). Residents of the commonwealth who are not eligible for Medicare shall continue to be eligible for the prescription advantage program pursuant to said section 39 of said chapter 19A.