Prescription Assistance Program Helps with Medicare Part D Doughnut Hole

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Prescription Assistance Program Helps with Medicare Part D Doughnut Hole


   ST. LOUIS, Sept. 18 /PRNewswire-FirstCall/ -- Nine months into the new
Medicare Part D program, many beneficiaries are finding themselves in the
program's "doughnut hole" coverage gap.
   Rx Outreach(SM), a patient assistance program (PAP) offered by pharmacy
benefit manager Express Scripts, can help Medicare Part D beneficiaries in
the "doughnut hole."
   Rx Outreach's PAP offers 90-day supplies of 110 primarily generic
medications from more than 40 therapeutic classes to treat most seniors'
health needs. The Rx Outreach program's only cost to the patient is a flat
administrative fee of either $20 or $30, depending on the prescription that
is dispensed.
   Many Medicare Part D beneficiaries have begun to enter the coverage gap
and more are expected to meet the same challenge in the coming weeks.
According to a June analysis by PriceWaterhouseCoopers LLC, this gap in
coverage is forcing more than 3.4 million beneficiaries to make tough
choices between the medications they should take and other expenses.
   Before reaching the doughnut hole in the Medicare Part D program,
patients pay the first $250 for their prescriptions, and then 25 percent of
their drug costs for the next $2,000. After that point, plan beneficiaries
are in the doughnut hole coverage gap until their out-of-pocket costs reach
$3,600. During this time, beneficiaries pay 100 percent of their
prescription costs. Upon reaching the $3,600 out-of-pocket limit, Medicare
Part D will begin covering a beneficiary's prescription drugs again.
   The amount paid to a program such as Rx Outreach may not be submitted
for reimbursement from Medicare and does not count toward the beneficiary's
out-of-pocket costs. Since individuals cannot apply the cost of the Rx
Outreach program to their out-of-pocket cost to get them to the $3,600
limit, each individual must determine based on his/her situation if a
patient assistance program will help reduce the overall cost of medication.
   Introduced in 2004, Rx Outreach is one of the first private-sector
solutions to help low-income individuals afford generic medications. Using
generic drugs, when medically appropriate, also helps cut costs. Generic
drugs have been proven safe and effective and account for more than half of
all prescriptions written.
   Rx Outreach enables participants to save an average of $100 per
prescription compared to the cost of the same medication if obtained
without insurance from a retail pharmacy. If a patient fills multiple
prescriptions, the savings could be hundreds of dollars per month.
   In addition to cost savings, Rx Outreach offers the convenience of a
90-day-supply and home delivery with each prescription. There is no
contract to sign or monthly fee to use this program. Enrollment in the
program is for a 12-month period.
   Rx Outreach has helped more than 400,000 individuals save more than
$140 million on their prescription medications. "Currently, 30 percent of
all Rx Outreach participants are seniors," notes Tina Jason, Express
Scripts senior director, Rx Outreach. "This program is a valuable resource
for seniors needing assistance covering the cost of their prescriptions."
   The program is available in every state and Puerto Rico to individuals
with incomes of up to $24,500 per year annually, which is 250 percent of
the federal poverty level. A family of four could have a household income
of up to $50,000 per year and meet the financial guideline.
   The Rx Outreach program is also available to individuals and families
that are not on Medicare. Patients who are uninsured or covered by another
medical or prescription drug program are also eligible to participate.
   For more information on Rx Outreach, including a complete list of
generic drugs offered and enrollment forms, visit http://www.rxoutreach.com
. For more information on generics, visit
http://www.express-scripts.com/pr/generics/ .
   About Express Scripts:
   Express Scripts, Inc. (Nasdaq: ESRX) is one of the largest PBM
companies in North America, providing PBM services to over 55 million
members. Express Scripts serves thousands of client groups, including
managed-care organizations, insurance carriers, employers, third-party
administrators, public sector, and union-sponsored benefit plans. Express
Scripts is headquartered in St. Louis, Missouri. More information can be
found at http://www.express-scripts.com .
   Media Contact: Rita Holmes-Bobo
   314-702-7584
   rholmesbobo@express-scripts.com