If the Governor and Speaker Donovan both don’t want this, I’d like to think they could get together and fix it.

According to the ConnPACE report for the period Jul-Dec 2008, ConnPACE spent $2.4 million on non-formulary drugs. That of course includes drugs that members are already taking and are already being covered by ConnPACE, so I estimate that 25% of the next month’s non-formulary drugs will be “new.” Coverage was only dropped for new prescriptions that are not part of members’ Part D formulary. So that’s 25% of 2.4 million or $600,000 for six months – $100,000 per month. According to the letter, this change was effective June 1 and would last at least until June 30th or whenever the new budget is passed, but may continue if the new budget does not have funding for non-formulary ConnPACE drug coverage.

Now as time goes by, and members move out of the program and are replaced by new ones – an evolution sure to be speeded up as life-saving drugs are no longer covered – the cost will go up as the percentage of non-formulary drugs that are “new” increases up to the point where they’ve turned over 100% of the members (or their non-formulary prescriptions) and the cost then will be, based on the latest period reporting, $400,000/month.

But even at $400,000/month the costs could be recoved through reasonable co-pays. If your raised the co-pay $10/prescription you cover the full cost of all non-formulary prescriptions. Not much when you consider that the average ConnPACE member gets 1.09 prescriptions per month. $10/month for the piece of mind that you won’t get sick and need a non-forumulary drug.

That this wasn’t thought through is not surprising from the folks in Hartford who saw no problem in just mailing this to their senior and disabled members on May 26th to be effective June 1. That’s not how you communicate with senior citizens – more consideration and publicitiy was given to the possible closing of State parks. Shameful.

Sorry for my ignorance, but could you explain how this works in a bit more detail? Is ConnPACE a plan that tops up Medicare Part D? They simply cover “non-formulary” drugs and drug costs in the donut hole? And for that seniors pay $20 a month in addition to the average of $36 for Part D? Is that correct? And how much of their coverage have ConnPACE actually eliminated? Sorry I’m so confused on this.

ConnPACE was established in 1996 to provide prescription drugs to low-income Connecticut seniors and disabled persons. Currently, if your income, including Social Security, is below $25,100 for singles or $33,800 for couples you are eligible for ConnPACE benefits (there are more details, but that’s the gist of it, there’s no asset test for regular ConnPACE. See http://www.connpace.com for more info).

Seniors pay ConnPACE an annual application fee of $30 and get their prescriptions for a $16.25 co-pay per prescription filled, and they can only be filled one month at a time. This went on until 2005 when Medicare Part D prescription drug program started. That program was not as good as ConnPACE, but it covered all seniors regardless of income. At that time, CT passed and the Governor signed legislation to “hold harmless” seniors on ConnPACE – meaning they were not going to toss the ConnPACE members onto Medicare Part D and drop the program. So ConnPACE became the secondary insurer. Basically, ConnPACE members continued to get their prescriptions for $16.25 and Connecticut reduced its costs by collecting the benifit, if any, that the member got from a Medicare Part D plan – saving a significant amount for the State. ConnPACE pays the monthy cost of Medicare Part D plans directly to the insurers. If Medicare D’s co-pay was $50, ConnPACE paid the cost to members down to $16.25. If Medicare Part D didn’t cover a particular drug, ConnPACE did and it continued to cost the member only $16.25 (remember, Medicare Part D plans vary in the drugs they cover). Most of the Medicare Part D plans have a “donut hole.” That is, they cover drugs up to a certain level, then stop and the senior has to pay for all their drugs up to a new $ amount, where the Medicare Part D plan kicks in. For ConnPACE members who’s drug costs have brought them into the “donut hole,” ConnPACE continues to pay – in other words, ConnPACE members were “held harmless” from reduced coverage because of Medicare Part D rules.

Hope this helps,
John

Medicare Part D plans all have different formularies and costs range from $15/month to $99/month with the more expensive plans covering more different drugs. Members can choose any plan they want, and ConnPACE pays the monthly premium (a federal requirement for state plans like ConnPACE).

Sorry for my ignorance, but could you explain how this works in a bit more detail? Is ConnPACE a plan that tops up Medicare Part D? They simply cover “non-formulary” drugs and drug costs in the donut hole? And for that seniors pay $20 a month in addition to the average of $36 for Part D? Is that correct? And how much of their coverage have ConnPACE actually eliminated? Sorry I’m so confused on this.