Governor Promotes Innovative Illinois Pharmacy Waiver Program as the New National Model

SPRINGFIELD -- Governor George H. Ryan today detailed an innovative prescription assistance program, Illinois SeniorCare, approved yesterday by President Bush and the United States Department of Health and Human Services as a new national model for providing assistance for all prescription medication to low-income senior citizens.

"I want to commend President Bush and Health and Human Services Secretary Tommy Thompson for working with us to provide relief to our senior citizens. SeniorCare is an innovative program that dramatically expands our continuing efforts to make prescription medication affordable for low-income seniors," said Governor Ryan. "This program is the first of its kind across the nation due in large part to the success we have had with the state's Circuit Breaker program. We hope other states will join us so that all seniors can receive the assistance they need to care for their health."

"Gov. George Ryan deserves credit for his efforts to improve access to affordable prescription drugs for Illinois seniors," U.S. Department of Heath and Human Services Secretary Tommy Thompson said. "Illinois now can use federal Medicaid dollars to extend prescription drug coverage to some 368,000 seniors."

The proposed program is modeled on the state's existing Circuit Breaker/Pharmaceutical Assistance program, administered by the Department of Revenue. Once enrolled, an individual would remain eligible for 12 months, and participants will have similar cost sharing responsibilities. The current Illinois Circuit Breaker program will continue to serve eligible seniors earning between 200 and 250 percent of the federal poverty level as well as disabled citizens.

"The state's innovative approach pools federal and state Medicaid dollars to help those seniors most in need. We also will make it easier financially and administratively for other states to quickly follow Illinois' lead," Secretary Thompson added.

Governor Ryan first presented his concept for this innovative prescription drug plan to the Secretary of Health and Human Services, Tommy Thompson, during a meeting in April, 2001 in Chicago. The proposal had been under preliminary review by the federal government since Illinois submitted its plan to the federal Centers for Medicare and Medicaid Services (CMS) on July 31, 2001.

"The lack of access to prescription drugs for the elderly is one of the most significant issues confronting our national health care system," Governor Ryan said. "This progressive initiative will provide an immediate benefit to Illinois seniors."

The new program will provide a broad pharmaceutical benefit to eligible low-income Illinois seniors age 65 and older. Those with annual incomes up to about $17,200 for a single person and $23,220 for a couple will qualify without being subject to an asset test. The program is scheduled to begin June 1, 2002.

Participants will pay a nominal co-pay of on average $3 per prescription. When an individual's pharmaceutical costs exceed $1,750, SeniorCare will pay about 80 percent of the cost of additional prescriptions, while enrollees will pay the remaining 20 percent plus the co-pay. The state does not plan to charge an annual enrollment fee for the program.

"Because the new program will cover such a broad range of drugs, it will benefit significantly more seniors," Governor Ryan added. "The increased cost of the program will be offset by federal matching funds, cost sharing features and drug manufacturer rebates paid to the state."

The new program will include a full range of drugs, including antibiotic, gastrointestinal, anti-anxiety, antihistamine and antidepressant therapies. The waiver program also will make diabetic testing supplies, hypodermic syringes, ostomy supplies and selected over-the-counter medications available to eligible seniors.

By providing seniors with affordable prescription drug, savings will be achieved by helping prevent costly institutional Medicaid care. Funding will be provided by state funds, federal matching funds, cost sharing features and drug manufacturer rebates paid to the state and federal governments.

"This program will provide a significant benefit for seniors taking prescription drugs," said Public Aid Director Jackie Garner. "For example, if a senior is taking three drugs, which cost $50 per prescription per month, the total annual cost is $1,800. Under SeniorCare, that same person would save about $1,700 a year by paying about $100 for an average $3 co-pay for a prescription," Garner said.

To encourage seniors to keep any private insurance coverage for prescription drugs, the program will allow individuals the option of receiving monthly rebate checks to help cover out-of-pocket expenses, including premiums, deductibles and co-payments for pharmaceuticals.

Illinois SeniorCare is scheduled to begin June 1, 2002. Highlights of the program are:

• Eligibility level (65 and over, 200% Federal Poverty Level)

• Coverage for up to 368,000 seniors

• Seniors already enrolled in the Circuit Breaker/PA program who are below 200 percent of federal poverty level will be automatically enrolled in Illinois SeniorCare and have a complete prescription formulary available to them

• Pays for over 90% of average eligible senior's drug cost

• No asset test or "spend down" requirements, as with traditional Medicaid