Joyce Pennington opened a letter from the state recently and got some unexpected news: At the end of this month, she will be dropped from an Illinois program that helps pay for prescription medications.
The 62-year-old Midlothian woman, who has severe lung and heart disease, broke into tears. "I thought, wait a minute, I've worked my whole life and now that I need some help they're treating me like this?" she said.
Nearly 43,000 low-income seniors and people with disabilities are finding themselves in similar straits as they learn they no longer qualify for Illinois Cares Rx, a popular program whose funding was slashed in half, to $53.7 million from $107.4 million, in the new state budget.
They represent residents who are deeply vulnerable as the economy flounders and the state pulls in the reins on spending: people with limited incomes who aren't among the poorest of the poor but who rely on some aid to meet living expenses they wouldn't otherwise be able to afford. Many are afraid that state and federal budget crises will prompt lawmakers to continue to cut programs that provide medical support.
Illinois Cares Rx is a lifeline for these individuals, filling in expensive gaps in Medicare prescription coverage for some, covering Medicare drug plan premiums and co-payments for others, and subsidizing the cost of medicine for everyone in the program.
With reduced funding, the state has narrowed the ranks of people who are eligible for Illinois Cares Rx to those earning no more than 200 percent of the federal poverty level; previously, people with incomes up to 240 percent of this standard qualified. For an individual, the new threshold for eligibility is now $21,780, down from $27,610.
The change will take effect Sept. 1; at that point about 173,500 people will remain on Illinois Cares Rx and face higher co-payments for prescriptions — in some cases, double the amount they were previously paying.
Hit even harder will be tens of thousands of vulnerable seniors and people with disabilities who are being eliminated from the program and who have to scramble to come up with alternative ways of paying for their medicine. Many are distraught and overwhelmed by that prospect.
Pennington was one of the few willing to speak openly about the hardship she faces.
She takes 14 medicines for her various ailments. The cost of filling most of those prescriptions will triple when Pennington leaves Illinois Cares Rx, and one will jump to $42 a month, up from $6.30 a month. Where she'll get the money is unclear. Pennington said she already owes $900 to the company that delivers her oxygen supplies and hundreds more to the hospital where she goes when her lung or heart problems flare up.
"I know everybody's hurting, and I don't like to ask for help," this grandmother said. "But now, it seems like I have nothing."
The situation is causing tremendous "fear and anxiety," as well as significant confusion, said Terri Gendel, director of benefits and advocacy for AgeOptions, the area agency on aging for suburban Cook County. "Some people are panicked, to the point of almost being hysterical. Others just say, 'I've been in this program for years so it must be a mistake.' They're in denial."
That's a problem because what people losing Illinois Cares Rx coverage need to do, above all else, is "come up with a plan" for dealing with their medicine needs, Gendel said.
Those being forced to leave the program fall, broadly, into two groups. The first consists largely of seniors and people with serious disabilities enrolled in Medicare who have prescription coverage through Medicare drug plans or managed care-style Medicare Advantage plans. In their case, Illinois Cares Rx "wrapped around" the Medicare plans, covering costs that consumers are required to pay out of pocket such as premiums, deductibles and co-payments.
Those can be considerable, with monthly Medicare drug plan premiums of $30, on average, and monthly co-payments for brand-name drugs starting at $38.25 and going as high as $91.
Pennington falls into this category: Despite her age, she qualifies for Medicare coverage and has a Medicare drug plan because she's permanently disabled and enrolled in Social Security's disability program.
Then there's the infamous "doughnut hole," a gap in Medicare drug plan coverage that opens up when an individual buys $2,840 worth of medicine in a year. (The amount will be slightly different next year.) Some relief is available to seniors, as medication charges to those in the doughnut hole have been reduced by 50 percent this year. Even so, the costs can be considerable, which is why Illinois Cares Rx aid to people who find themselves in the Medicare doughnut hole is so helpful.
For this group, which has Medicare coverage, the most important immediate advice is "pay your monthly (drug plan) premium, because if you don't, you could lose your Medicare drug benefits," said Jim Parker, deputy administrator for medical programs at the Illinois Department of Healthcare and Family Services.
That's going to be a hardship for John Prykop, 80, and his wife, Helen, 73, who between them take eight drugs for heart disease, high cholesterol, vertigo, emphysema, rheumatoid arthritis and thyroid disease. The Hometown couple's income is $30,600 a year, just slightly above the new eligibility limits for Illinois Cares Rx.
"We don't have the money" to pay $62 monthly to cover premiums for Medicare drug plans for two people, John Prykop said. "We're between a rock and a hard place. What I have to do is find out from my doctor if any of these medications we're on can be stopped."
The second group being forced out of Illinois Cares Rx consists largely of people with disabilities who aren't on Medicare and don't have any drug coverage through that government health program.
Options for this group include discount drug cards, low-cost medicines available at retailers such as Target or Walgreens, drug company prescription assistance programs, and aid from organizations that advocate on behalf of people with specific illnesses, Gendel said.
Illinois is hardly the only financially pressed state scaling back its prescription assistance program; South Carolina shut down its program last year, Arizona did the same the year before, and several other states are eyeing or implementing cutbacks, experts said.
The program became a target as the state faced a gaping budget deficit but could not cut Medicaid benefits because of federal requirements that states maintain existing commitments to that program. "We were very limited in what we could do," said Parker of the Illinois Department of Healthcare and Family Services, referring to the need for budget cuts.
Because a large percentage of those being cut from the state drug program have Medicare coverage, the impact will be mitigated, Parker suggested. "Many people may think they have lost all their drug coverage, but that isn't the case" since their Medicare plans will still be in place, he said.
If you lose coverage through Illinois Cares Rx, options are available to help you understand your situation and get other assistance:
•Start by calling the Health Benefits Hotline at 800-226-0768 or the Senior HelpLine at 800-252-8966 for more information.
•Talk to your doctor and your pharmacist. Ask for drug samples. Find out if you can switch to lower-cost generic drugs or if you can safely stop taking one or more medicines altogether.
•Check out drug company programs that help people pay for prescription medicine. Information about prescription assistance programs is available at rxassist.org, rx4illinois.org and rxoutreach.org.
•If you're a veteran, inquire about drug coverage offered through the Department of Veterans Affairs. If drug coverage might be available through a spouse's private insurance plan, explore that alternative.
•Consider filling prescriptions at pharmacies with discount programs offered by retailers such as Walgreens, Target, Walmart, Kmart and Sam's Club.
•Think about signing up for a discount drug card. Examples include the Illinois Rx Card (illinoisrxcard.com), Needy Meds (needymeds.org) and discount cards offered by various counties (caremark.com/naco).
•Visit websites run by makers of brand-name drugs and look for coupons or rebates. Look at internetdrugcoupons.com. Be sure you understand how coupon offers interact with your Medicare drug plan.
•Contact organizations that focus on patients with specific illnesses, such as cancer or diabetes. Sometimes these groups help cover co-payments. For a list of resources, go to bit.ly/qyeDoQ.
•Ask your local church, county, township or social service agency if it can offer short-term financial assistance to help you get through this transition.
•Re-evaluate which Medicare drug plan works best for you, given your changed circumstances. Call the Illinois Senior Health Insurance Program for help at 800-548-9034. Or visit Medicare's website at medicare.gov or call Medicare staff directly at 800-633-4227.
•Be sure that you start paying monthly premiums for your current Medicare drug plan; if you don't, that coverage could be canceled and all support for your drug bills eliminated.Copyright © 2014, The Baltimore Sun