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January 12, 2006

Governor Blagojevich announces emergency measure to ensure no low-income Medicare Part D beneficiary is turned away at pharmacy
Illinois is first highly populated state to provide critical protection to dual eligibles while kinks in federal program are being addressed

CHICAGO – Governor Rod R. Blagojevich today announced that Illinois will cover the cost of prescription drugs for dual eligible citizens--those enrolled in Medicare and Medicaid--who were otherwise being turned away from pharmacy counters across the state due to glitches in the new federal Medicare Part D drug program. Adding to the ongoing efforts of the Blagojevich Administration, this new safety net will ensure seniors and persons with disabilities won’t go without the drugs they need while the federal government corrects discrepancies with enrollees’ records.
“It’s unacceptable that any Illinois senior or disabled person who is entitled to Medicare’s low income drug coverage is leaving pharmacies without the prescription drugs they depend on,” said Governor Blagojevich.  “Hopefully the glitches with the federal program will be worked out soon, but until then, we’re going to take care of those who need their prescription drugs to remain healthy.”
Since the new Medicare Part D program began on January 1, 2006, many dual eligible seniors and persons with disabilities have been complaining that their pharmacists had no record of their Medicare Part D enrollment or that they were being charged prices they simply couldn’t afford because the pharmacist did not have information on their low-income subsidy eligibility.
Starting today, if a pharmacist is having problems properly billing the Medicare prescription drug plans (PDPs) for someone who is dually eligible, or if their low-income eligibility information is lacking they can call or fax the individual’s information to the Illinois Department of Healthcare and Family Services (HFS).  On a case-by-case basis, HFS staff will work with the pharmacist to solve the problem.  If the problem can’t be fixed quickly, the state will cover the cost of the prescription drugs directly, and then seek reimbursement from the prescription drug plan the patient is assigned to.  Under the new system, no dual-eligible senior or disabled person will leave a pharmacy without the medications they need.
“We will continue to provide this critical protection to our seniors until the problems with the new Medicare program are worked out,” said HFS Director Barry Maram.
After a pharmacist has provided the details of a case, HFS, when necessary, will temporarily recode the individual’s eligibility so that the claims will be paid directly by HFS.  Once proper billing information becomes available for the patient, pharmacies will void their claims to HFS and then bill the PDP directly.
Governor Blagojevich continues to encourage seniors and persons with disabilities across the state to take advantage of the benefits of the Illinois Cares Rx and Medicare Part D prescription drug benefits.  The Governor also urged Illinoisans to use the state resources in navigating the new Medicare program’s enrollment process.  
Governor Blagojevich’s ongoing efforts to help seniors through the Medicare Part D program are part of his long standing effort to make sure that more people get more health care and better benefits, protect coverage for those who have health care, and help hospitals, doctors and nurses provide better health care.  Under the Blagojevich Administration, Illinoisans benefit from a wide array of programs designed to assist them with the high cost of prescription drugs: SeniorCare, Circuit Breaker (now Illinois Cares Rx), the Rx Buying Club and the I-SaveRx drug importation program.


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