Aspect of Need Addressed: Medical, Financial
The question is...
...when required to switch to a new Part D prescription drug plan, can my son maintain access to all the medications he needs within a plan that covers all their costs as to which he is entitled as a "dual eligible" disabled?
The answer is...
Yes... I think...
But the condition to the answer is...
...as long as NJ Medicare continues to pay for benzodiazepines even when they are not listed in Medicare's Part D formulary.
My quest sought to address two issues: access and cost. As to access, we had to assure that my son could get the medications he needed, without exception. As to cost, could we get the access he needs within one of the "benchmark" plans open to "dual eligibles" like my son?
My quest got off on the wrong track, due to my insufficient understanding. Eaerly on I got confused when misunderstanding that "dual eligibles" in New Jersey had only six plans from which to choose. I thought that dual eligibles were restricted only to these six plans. In fact, they can enter any of the 45 plans available in New Jersey. But they would have to pay those amounts above those payments made by NJ Medicaid.
After more research this afternoon, I finally found my answer. It came from a very knowledgeable call center worker at Medicare and from a very helpful local pharmacist at CVS in my home town.
The question is...
...when required to switch to a new Part D prescription drug plan, can my son maintain access to all the medications he needs within a plan that covers all their costs as to which he is entitled as a "dual eligible" disabled?
The answer is...
Yes... I think...
But the condition to the answer is...
...as long as NJ Medicare continues to pay for benzodiazepines even when they are not listed in Medicare's Part D formulary.
My quest sought to address two issues: access and cost. As to access, we had to assure that my son could get the medications he needed, without exception. As to cost, could we get the access he needs within one of the "benchmark" plans open to "dual eligibles" like my son?
My quest got off on the wrong track, due to my insufficient understanding. Eaerly on I got confused when misunderstanding that "dual eligibles" in New Jersey had only six plans from which to choose. I thought that dual eligibles were restricted only to these six plans. In fact, they can enter any of the 45 plans available in New Jersey. But they would have to pay those amounts above those payments made by NJ Medicaid.
After more research this afternoon, I finally found my answer. It came from a very knowledgeable call center worker at Medicare and from a very helpful local pharmacist at CVS in my home town.
From my Medicare call center friend, I was relieved to learn that my son's access to all his medications could be assured. Some plans may offer to cover such medications as Medicare will not, but charge a premium to cover their cost. (In fact, Aetna offers a very reasonable plan like this. Aetna's formulary includes all the benzodiazepines which my son had listed, but charged a moderate monthly premium of $7.29.)
I was also pleased to learn--not from NJ Medicaid (or from Mercer County Board of Social Services, the NJ SHIP Counselors, or Social Security's Trenton office, all of which I personally visited yesterday), but from my local pharmacist!--how NJ Medicaid really works. NJ Medicaid apparently pays for benzodiazepines as long as they are correctly prescribed and used, no matter what the restrictions in the formularies of the Medicare Part D providers who are the primary insurers. This means that, contrary to my worry, my son can enter a Part D plan in which his benzos are not in the formulary, knowing that NJ Medicare will cover them after payment is rejected by the primary insurer.
Getting to this conclusion has been exceedingly difficult and frustrating. Part of the problem was my misperception of a note in a yellow form letter from Medicare. But more of the problem is due to the very opaque NJ Medicaid system. Nowhere could I find a posted NJ Medicare formulary. Getting through to the NJ Medical Customer Center was also difficult. Even the helper behind the glass at the Social Security office became exasperated with NJ Medicaid. It was she who suggested that the best person for me to call about NJ Medicaid was... my local pharmacist!
To conclude, then, two questions:
1. Will Medicaid get better or worse with Obamacare?
2. How does a psychiatrically impaired individual navigate such a thing as changing Part D prescription drug plans on his own?
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