Emergency Drug Coverage for Medi-Medi’s Extended 2 Weeks
[Posted 03/23/06]

Governor Schwarzenegger Wednesday announced that the state’s emergency drug coverage program for “dual-eligible” seniors has been extended until April 16.

Nearly 1 million “medi-medi’s” (California seniors who are covered by both Medicare and Medi-Cal) were transferred on January 1 into the Medicare Part D prescription drug program. Previously, these low income and disabled seniors received drug coverage through Medi-Cal. Unfortunately, the transition went badly, and many seniors had difficulty getting their prescription medications. As a result, 37 states—including California—stepped in and began providing emergency drug coverage. California’s coverage, originally set to expire March 31, has been extended until April 16.

A variety of additional problems may be encountered by these new Part D participants once the emergency state program ends. Patients may or may not need to change prescriptions depending on the formulary of the Part D plan they have selected. If patients find that their plans’ formularies do not cover their drugs, they or their physicians can request an exception (coverage authorization for nonformulary drugs). If an exception is denied, the decision can be appealed. Unlike Medi-Cal, Part D exceptions or appeals cannot be submitted by pharmacists, only by Medicare beneficiaries and their prescribing physicians.

Click here for more details, including drug plan contacts and information on appealing a coverage decision.

Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.