Prescription Drug Programs

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Prescription drugs can now effectively treat a wide variety of illnesses and diseases for which little help was available only a few years ago. Unfortunately, methods of paying for prescriptions have not kept pace. Whether or not you have full insurance coverage, cost can be a serious concern. Call the HelpLine at 1-800-965-7476 for more information or help with any of the programs listed below. What you'll find on this page: DEL (Low Cost Drugs for the Elderly or Disabled) Maine Rx Plus $4 Generics Prescription Assistance Programs Free Samples Safely Ordering Drugs from Canada Help with Private Insurance Co-pays TRICARE Medicare Part D Veterans Benefits HIV/AIDS Program Hospital Programs MedAccess Drug Safety, Effectiveness, and Cost	...	Online Guide to Navigating Maine's Health Care System Helpful programs for... Kids and Parents Pregnant Women Young Adults Disabled or Elderly Adults Other Adults What does national health care reform mean for... Kids Young Adults People with Medicare Everyone with Insurance Help for Immigrants Frequently Asked Questions Health Insurance Marketplace Businesses Other helpful programs for many groups of people: Apply for MaineCare Online! COBRA Dental PT Worker Voucher Programs Hospital Programs Health Center Programs Mental Health Prescription Drug Programs Private Insurance Substance Abuse Other Resources Getting Quality Health Care Health Insurance Literacy

 

DEL (Low Cost Drugs for the Elderly or Disabled)
This is a discount program offered through the Department of Health and Human Services (DHHS). Many people who are either disabled or 62 and older who do not qualify for MaineCare, can get this help. DEL provides an 80% discount off the cost of many commonly used drugs. Some people with high medication costs may be able to get coverage of less commonly used drugs. For people who already have Medicare, DEL does not take the place of Part D (Medicare prescription coverage). But, it may help to "wrap around" the Part D coverage in some cases. If you are eligible, it is good to apply for DEL.

What about "Estate Recovery?"
Estate Recovery does NOT apply to this program. Estate Recovery is when DHHS attempts to recover the cost of MaineCare services from an enrollee's estate once they have passed away, if they have no surviving spouse or dependants, and if they had MaineCare when they were age 55 or over. This can apply to some people enrolled in full coverage MaineCare (another program offered through DHHS), but NOT to people enrolled in DEL.

Asset guidelines
Assets do NOT count against you when applying for this program.

Income guidelines
For self-employed income, use your net income (after business expenses and taxes). For all other income types, use the gross amount (the amount before any taxes or expenses are taken out). Even if your income is above the levels listed you should apply anyway! If you spend a lot of money on medication, you could have higher income and still qualify. If you have questions, or are unsure whether you qualify, call our HelpLine at 1-800-965-7476.

2013 Monthly Income Guidelines for DEL (Low Cost Drugs for the Elderly or Disabled) Family Size Income 1 $1,676 2 $2,262 3 $2,849 4 $3,435 5 $4,021 6 $4,607 For each additional family member add: $587

Note: Some money can be "disregarded" or ignored when applying. So even if you are a little over income guidelines listed above, you should apply anyway. If you are unsure, call our HelpLine at 1-800-965-7476.

Maine Rx Plus
This is a discount program offered through the Department of Health and Human Services (DHHS). Many low and middle-income people who do not qualify for MaineCare, can get this help. Maine Rx Plus provides a 60% discount off the cost of many commonly used generic drugs at many pharmacies across Maine (only 15% off brand-name drugs). For people who already have Medicare, Maine Rx Plus does not take the place of Part D (Medicare prescription coverage). But, it may help to "wrap around" the Part D coverage in some cases. If you are eligible, it is good to apply for MaineRx Plus. (note: double check the income guidelines the application may not be up to date.)

What about "Estate Recovery?"
Estate Recovery does NOT apply to this program. Estate Recovery is when DHHS attempts to recover the cost of MaineCare services from an enrollee's estate once they have passed away, if they have no surviving spouse or dependants, and if they had MaineCare when they were age 55 or over. This can apply to some people enrolled in full coverage MaineCare (another program offered through DHHS), but not to people enrolled in Maine Rx Plus.

Asset guidelines
Assets do NOT count against you when applying for this program.

Income guidelines
For self-employed income, use your net income (after business expenses and taxes). For all other income types, use the gross amount (the amount before any taxes or expenses are taken out). Even if your income is above the levels listed you should apply anyway! If you spend a lot of money on medication, you could have higher income and still qualify. If you have questions, or are unsure whether you qualify, call our HelpLine at 1-800-965-7476.

2013 Monthly Income Guidelines for Maine Rx Plus Family Size Income 1 $3,352 2 $4,524 3 $5,697 4 $6,869 5 $8,042 6 $9,214 For each additional family member add: $1,173

Note: Some money can be "disregarded" or ignored when applying. So even if you are a little over income guidelines listed above, you should apply anyway. If you are unsure, call our HelpLine at 1-800-965-7476.

$4 Generics
Another way to save on prescriptions is by switching to generic. Generic medications are usually much cheaper than “brand name” drugs and may make it easier to find discounts. Many big retail store pharmacies have started providing many generic medications for only $4, regardless of your income or insurance status. Smaller, local pharmacies sometimes have generous discount programs as well. It’s a good idea to call the pharmacies nearest to you and ask about any discount programs that they offer!

Help with "Brand Name" Drugs
State prescription assistance programs like Maine Rx Plus can be helpful, but sometimes those programs don’t help enough. Community-based Prescription Assistance Programs (CPAPs) can search through their database to find other programs to help with the cost of medications. The CPAPs keep the latest information on a large number of drug company discount cards and discount programs for specific drugs. Staff can provide you with free information and help you to apply for discounts. Click here for more information.

Free Samples
Sometimes Health Center, Hospitals, and Free Clinics are given free samples of certain medications that they can share with their patients. This assistance is usually not a long-term solution, but can definitely help! Whenever you are prescribed a medication, it never hurts to ask if there are free samples available.

Ordering Drugs from Canada
For information about mail-ordering drugs from Canada, visit the Health Canada Web site to learn how to protect yourself from fraudulent companies, or call the Maine Citizen Leadership Fund (207-780-8657).

Help with Private Insurance Co-pays
Even if you have insurance coverage, cost may still be an issue. Some people may be able to get help paying their co-pays if they meet certain income and medical guidelines. For more information visit the Patient Advocate Foundation's Co-pay Relief web site. Call the HelpLine at 1-800-965-7476 for more details.

TRICARE
Military retirees, and some family members or former spouses age 65 and older may be eligible for two programs provided by the Department of Defense: TRICARE for Life and the TRICARE Senior Pharmacy Program. For more information and complete eligibility requirements for the TRICARE for Life and TRICARE Senior Pharmacy Program, contact Sierra Military Health Services (the Northeast Regional Contractor) toll free at 1-888-999-5195.

Medicare Part D
If you are eligible for Medicare, you can get prescription coverage through "Part D" of the Medicare program. Part D plans are offered through a variety of private companies. It can be difficult to figure out which company to go with because each plan covers different drugs at different levels. Many people have to pay a monthly premium for a Part D plan - But many Maine people qualify for programs that pay this premium for them. If you qualify for a Medicare Savings Program, many of your Medicare costs will be paid for you. Part D is optional, though if you do not sign up for it within a certain time frame, or have other "creditable" coverage in its place, you will have to pay a higher premium rate for Part D in the future. For help figuring out which Part D plan is best for you, if you qualify for "extra help" with your Part D costs, and for information about how the new Part D will affect your state-based prescription coverage, you can contact your local Area Agency on Aging at 1-877-353-3771 for assistance and referrals.

Veterans Benefits
CHAMPVA is a health care benefits program through the Department of Veterans Affairs (VA). For the spouse or widow(er) and for the children of a veteran who: is rated permanently and totally disabled due to a service-connected disability; was rated permanently and totally disabled due to a service-connected condition at the time of death; died of a service-connected disability; died on active duty and the dependents are not otherwise eligible for DoD TRICARE benefits. Under CHAMPVA, VA shares the cost of covered health care services and supplies with eligible beneficiaries.

HIV/AIDS Assistance
If you have been diagnosed with HIV/AIDS and you are a resident of Maine, you could get assistance from the State of Maine to get HIV-related medications free of charge. The Aids Drug Assistance Program (ADAP) is a program of the Maine Center for Disease Control and Prevention (Maine CDC), HIV/STD Division. If you are interested in ADAP contact the Maine CDC at (207) 287-2899. You can also contact one of the HIV/AIDS organizations in the state or contact the AIDS Hotline at 1-800-851-2437.

Hospital Programs
Many hospitals in Maine provide free or reduced-cost emergency services to people at certain income levels. Some hospitals go above and beyond just the emergency services and will also provide help with medications and other services. For more information, check out our page on Hospital Programs, or call the HelpLine at 1-800-965-7476.

MedAccess
MedAccess works with individuals and health care providers to identify ways patients can save money on prescription medications. The free program, administered by MaineHealth, helps patients and health care providers evaluate options such as pharmaceutical companies' patient assistance programs, low-cost generic programs, and Medicare Part D and state and local prescription programs that can help save on prescription medication costs. Click here for more info: http://www.mmc.org/mh_body.cfm?id=4002. MedAccess is part of the MaineHealth CarePartners Program.


Drug Safety, Effectiveness, and Cost

Consumer Reports Health Best Buy Drugs™ offers free, trusted educational resources to help patients access the safest, most effective, and most affordable prescription drugs available. This resource is a grant-funded project providing independent, evidence-based reports on prescription drugs based on research conducted at the Drug Effectiveness Review Project, headquartered at the Oregon Health & Science University. Consumer Reports Health "translates" findings into consumer-friendly reports that are available for free. These reports identify drugs that are as effective and safe as others in its class but often available at a lower cost, as well as provide information about the underlying condition. These recommended drugs are often generic drugs, but in the case that a brand-name drug is superior to a lower-cost drug in safety or efficacy, it is recommended regardless of price. The reports are freely accessible at: www.crbestbuydrugs.com, and also available for free in magazine format.

AARP's Drug Savings Tool provides the Consumer Reports Health Best Buy Drugs™ information in a different format to further help people learn about and pay less for the prescription drugs. Visit the tool at http://drugsavings.aarp.org/.

Prescription Policy Choices is a Maine-based non-profit that works to promote access to affordable, safe and effective prescription drugs. PPC is foundation-funded and receives no financial support from the pharmaceutical industry. Because PPC and Consumer Reports Health share the vision that consumers should be empowered to make evidence-based choices, PPC helps to distribute Consumer Reports Health Best Buy Drugs™ materials in Maine. If you would like to receive a free shipment of these magazines, please contact Jennifer Reck at Prescription Policy Choices at jreck@policychoices.org or at 512-2138.