|
The Pharmaceutical Assistance program was created by the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act through the extension in 1985 of the enabling legislation for the Circuit Breaker tax relief program. The program was designed to give low-income senior and disabled residents access to essential medication. Each year, a participant “purchases” Pharmaceutical Assistance coverage at nominal cost and receives approved prescription medication through participating pharmacies. Each participant is issued a Pharmaceutical Assistance card, which validates his or her participation in the program and shows the effective dates of coverage.
Eligibility requirements To receive Pharmaceutical Assistance, the applicant must Applying for benefits An applicant may be eligible for Pharmaceutical Assistance regardless of whether or not he or she receives a Property Tax grant. To apply for Pharmaceutical Assistance, the applicant should file Form IL-1363, Application for Illinois Cares RX Basic. Drugs covered Illinois Cares Rx Basic (formerly Circuit Breaker Pharmaceutical Assistance) covers drugs used in the treatment of the following diseases – Illinois Cares Rx Plus (formerly SeniorCare) covers almost all prescription drugs. Illinois Cares Rx Basic and Illinois Cares Rx Plus cover both generic drugs and brand name drugs. There is a separate preferred drug list (PDL) for each plan. The preferred drug list is a list of some types of drugs, but not all, that are covered by your card. A drug listed as "preferred" on the PDL can be obtained at a participating pharmacy without any additional approval required. A drug that is listed as "non-preferred" requires an extra step called prior approval before the program will pay for it. Your pharmacy or doctor’s office may call to request prior approval of a non-preferred drug. If the request is approved, your pharmacy will be able to fill your prescription within 24 hours. If the request is denied, you will receive a denial letter in the mail. You have the right to appeal the denial of a prior approval request. Your doctor can use your plan’s PDL to prescribe a preferred product if it is medically appropriate.
Costs to the participant If you are eligible for Medicare, your out-of-pocket expenses might include:
Co-payments After Medicare and Illinois Cares Rx have paid $1,750 in benefits on your behalf in a calendar year, you will pay 20 percent of the cost of each prescription in addition to the applicable co-payment. After $5,100 in prescription drug benefits, your co-insurance will drop to 5 percent. *NOTE: Your out-of-pocket expenses may be less if you are eligible for "extra help" under Medicare Part D. If you are NOT eligible for Medicare, your out-of-pocket expenses might include:
Co-payments
- $2 for generic drugs After Illinois Cares Rx has paid $1,750 in benefits on your behalf in a calendar year, you will pay 20 percent of the cost of each prescription in addition to the applicable co-payment.
Also included in the Circuit Breaker program is tax relief and reduction on license plate sticker cost. Certain applicants may receive a grant back from the amount of tax they paid. Each applicant will also be able to receive their sticker at a cost of $24.00. You can still receive this benefit even if you do not want to apply for the pharmaceutical card. ECCOA offers free Circuit Breaker filing. Just contact the CCU office in the county in which you reside to make an appointment or to see if you are eligible for this program. In Clay County contact: Nancy Byers – Senior Services of Clay County –832 west North Ave., in Milt`s Alley – Flora, IL 62839 662-7304 or toll free-1-888-618-7304. Effingham County: Lea Ann Sapp– Senior Services of Effingham County – 209 S. Merchant Street – Effingham, IL 62401 347-5569 or toll free- 1-800-212-1790. Fayette County: Ginger Hamilton-Senior Services of Fayette County – 109 S. Fifth – Vandalia, IL 62471 283-4122 or toll free 1-866-618-4122. Jefferson County: Senior Services of Jefferson County – 409 Harrison – Mt. Vernon, IL 62864 – 242-3505. Marion County: Kay Crooks or Jessica Pryor – Senior Services of Marion County – 120 E. Green – Centralia, IL 62801 – 533-4300 or toll free: 1-800-295-2903. |