[Or-senate-23] Join the Oregon Prescription Drug Program (OPDP)Purchasing Pool

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s. fuchs dc

From Senator Avel Gordly :

August 20, 2007

From the Office of Senator Avel Gordly

Senate District 23

Contact: Cruz, Chief of Staff (503) 288-0837 or reply to this

email

“Our lives begin to

end the day we become silent about things that matter.” – Luther King, Jr.

1. Join the Oregon

Prescription Drug Program (OPDP) Purchasing Pool

2. Frequently Asked Questions (FAQS) regarding the Oregon

Prescription Drug Program Purchasing Pool

3. Frequently Asked Questions about OPDP and Medicare Part D

Prescription Drug Coverage

NOTE: Many thanks to Senator Bill ette for suggesting this

topic.

1. Join the Oregon

Prescription Drug Program Purchasing Pool

All Oregon

residents should become aware of the

new expanded Oregon Prescription Drug Program.

The expanded Oregon Prescription Drug Program

(OPDP), passed by the 2007 Legislature, is in place and open to every person in

the state of Oregon,

free of charge.

Measure 44 was passed by the voters in 2006 by a vote of 79

percent.

We took it one step further during the landmark 2007 legislative

session and opened the

program to the

‘underinsured’ of all ages and income

– regardless of whether or not they are already covered by an existing

policy.

Every Oregon

resident is entitled to join the OPDP purchasing pool to get the best price

possible with your free card.

How do you know if you qualify as being underinsured?

If you do not have health insurance, you qualify.

If you already have insurance and the drug costs more

using your present insurance card than it does by using the OPDP card –

you’re underinsured.

You can enroll on line at www.opdp.org, or by calling the ODS Companies

directly at 1-800-913-4146.

This is the first concrete step towards our goal of creating

universal health care coverage in Oregon,

and you owe it to yourself and your family

to get a free card and save up to 60% on your prescription purchases.

The average savings is about 30%.

These savings are the result of utilizing a large purchasing pool,

so everyone will benefit by your enrollment.

The Oregon Prescription Drug Program is administered through the

Office for Oregon Health Policy & Research.

2. Frequently Asked Questions (FAQS) regarding

the Oregon Prescription Drug Program Purchasing Pool

A. Eligibility:

To qualify for this program you must:

Be an Oregon

resident with no prescription drug coverage other than Medicare Part D, if

applicable

OR you must be an Oregon

resident who considers yourself underinsured for prescription drug coverage.

Each person may enroll online at www.opdp.org, or by calling The ODS Companies directly at 1-800-913-4146.

A parent may enroll a child using one of these options.

A guardian/personal representative/attorney-in-fact may enroll a

person in their charge in the same ways.

Braille or large print Call 1-800-913-4146 for an alternate format.

Am I an Oregon

resident?

You are an Oregon

resident if you reside in Oregon

What is

meant by “underinsured”?

With the 2007 passage of SB 362 the underinsured are now able to

enroll in the OPDP.

If an Oregonian considers himself or herself underinsured for Rx

coverage they may enroll and use their OPDP cards to receive a discount on

prescriptions they are purchasing. If a member has Rx insurance they

should verify with their carrier that those Rx purchases made using the OPDP

discount card will be accumulated toward their out of pocket expense.

Although the OPDP discounts are market competitive, if a member

has an insured benefit they may also have a competitive discount that could

offer an equal or better rate on their specific prescription. Members

should be wise shoppers and see which card brings the best price for their

prescriptions.

This program is for people without health insurance or those who

have insurance but could use help paying for prescription drugs in specific

situations.

Some situations could include the following:

They are on

Medicare and fall into the “gap” where they pay 100 percent of

drug costs. (Many Medicare prescription drug plans have a

“gap’ in coverage after drug costs reach a certain point and

before catastrophic coverage begins and the plan pays the bulk of costs.)

They need a

prescription drug their insurance plan formulary doesn’t cover.

Note that they could not use this cost to accumulate toward their out of

pocket expense for their Plan’s deductible since the Rx wasn’t

covered.

They have a deductible

and use the drug discount program to reduce their out of pocket costs.

Note, their carrier may have a discount for out of pocket expenses too.

They may only use one card not both.

They are waiting to

have a pre-existing condition covered by their insurance plan.

They are a new

employee lacking insurance and are waiting to become eligible for the

employer plan.

Their medical

coverage does not offer Rx benefits.

All prescription drugs prescribed by a licensed Oregon

clinician are eligible for a discount through this program.

B. When do I become a member of OPDP?

When does coverage start?

Coverage starts as soon as you receive your I.D. Card.

How long should it take to receive an I.D. card?

You should receive an I.D. card within one week.

C. What pharmacy will I go to?

A brochure with the list of pharmacies is included with the I.D.

card. The pharmacies are also listed on our website: www.opdp.org or call customer service at 800-913-4284. New pharmacies can

join at any time, so view the website for the most current list of pharmacies.

You can also ask the pharmacy that you usually do business with if they are

part of the OPDP. You can advise them to go to our website if they wish to

join our network.

D. Prescription Coverage and Cost

Are all my prescriptions covered?

All prescriptions prescribed by a licensed Oregon

clinician are eligible for a discount. This program does not give discounts

for over-the-counter drugs, which are drugs you can purchase without a

prescription.

Will this program cost me anything to join?

There is no membership fee for enrolling in this program. Should

a nominal fee ever become necessary you will have no obligation to remain in

the program.

How do I find out if I could get a cheaper drug?

Ask your physician or pharmacist if there is a generic or

equivalent drug that may be cheaper than the drug you are prescribed? Or, if

you are a member you can go to www.odscompanies.com and register. Once

registered, click on “Pharmacy” in the top blue bar. Next, click

on “Formulary Look Up” tab under Resources. This will take you to

the site to look up drug costs, and will show you if a generic is available for

a brand name drug. If you have trouble using this site, please call

1-800-913-4284.

How much of a discount will I receive?

Discounts will vary depending on whether a drug is generic or

brand. The greatest discounts are on generics and they can be as high as 60%!

The average discount is probably about 30%

What is a brand Rx or a generic Rx?

Brand drugs are still on patent so they are only manufactured by

one company. Because there is no competition, these are the most expensive

drugs.

Generic drugs are made when a drug comes off of patent. Several

manufacturers can now make the drug so competition drives the cost down. The

FDA finds generics as safe as brand name drugs. Also, evidence-based research

has shown that higher cost brand drugs are NO MORE effective than lower cost

alternatives.

The pharmacy I went to charged me more for an Rx

than the pharmacy that I went to last month.

In the instance described in the question above here is what could

have happened:

First Pharmacy Second

Pharmacy

Rx is sold for $4 Rx

is sold for $10

OPDP negotiated discount price = $5 OPDP discounted

price = $5

You pay $4 under OPDP contract You

pay $5 under OPDP contract

On a given day, the OPDP discounted price will be the same from

pharmacy to pharmacy. However the OPDP rate is based on a discount off of the

Average Wholesale Price and that can change day to day. If a pharmacy has a

special program that offers the drug for less than OPDP’s price the

pharmacy must sell it to you for the lower amount according to their contract

with OPDP.

Keep in mind that drug prices frequently change. Also remember

that pharmacy promotions are generally on certain drugs but not all drugs.

Just like when you’re shopping for groceries you will see some products

on sale but not all of them. Your OPDP discount card will bring you a discount

on all Rx. The best discounts are on generic drugs.

3. Frequently Asked Questions about OPDP and

Medicare Part D Prescription Drug Coverage

If I enroll in Medicare Part D drug coverage why

would I want to continue to use my OPDP discount card?

The OPDP discount card may give you a better discount than your

Plan gives you when you are paying 100% of the drug cost. You will pay 100% of

your drug costs when you are meeting a Plan’s deductible or during the

“gap in coverage”. For some of the Part D plans this gap happens

when individual’s prescription drug expenses are between $2,250 to $5,100

in a given year and they are responsible for 100% of their drug costs.

If I am enrolled in Medicare Part D drug coverage

and I use my OPDP discount card why do I have to send my receipt to my Part D

Health Plan?

If you want your OPDP expenses to apply towards your Medicare Part

D costs, you must send your receipt to your Medicare Plan. Right now, the only

way to get this information to your Plan is to send it in by mail. If that

changes we will notify you. In the meantime it is very important to send the

paper receipt to your Plan and notify them that it needs to be credited toward

your Medicare deductible and out–of-pocket expense.

What if I am enrolled in a Medicare Part D Plan

and I want to use my OPDP discount card on a drug not covered by my Medicare

Plan drug list?

If the prescription drug is not on your Medicare Plan’s drug

list, it cannot be counted toward your out-of-pocket expenses. However, every

Medicare Plan has an exception and appeal process that you can follow to ask

the Plan to pay for drugs that are not on their list. If the Plan approves

your exception, your drug costs can count toward your Medicare deductible.

What if I am enrolled in a Medicare Part D Plan

and I want to go to a pharmacy that is not on that Plan’s network but it

is on the OPDP network?

You may go to a pharmacy on the OPDP plan and use your discount

card. However, you should check with your Medicare Plan if you intend to use a

pharmacy not on their list to make sure they will honor the receipt for your

prescription as Part D expense.

I’m confused and don’t know whether

to join Medicare Part D or not, what should I do?

You can call 1-800-Medicare (1-800-633-4227) or your Medicare

health plan for questions about your Medicare options. You can also call the

Senior Health Insurance Benefit Assistance (SHIBA) program at 1-800-722-4134

for assistance.

I don’t want to sign up for Medicare Part

D, can I stay on the OPDP?

You may remain an OPDP member and use your card for discounts at

OPDP pharmacies. However, you need to know that individuals who are eligible

for Medicare Part D who choose not to enroll by May 15, 2006 will have a 1% per

month penalty applied to their premium when they do enroll. In other words, if

you choose to enroll a year later, your premium will be 12% higher.

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