State Pharmaceutical Assistance Program: Texas

When people become eligible and start receiving Medicare benefits, they don’t expect that they will struggle to pay for their medications. Many people don’t expect the expense of Medicare Part D prescription drug plans because they have gotten used to employer benefits. There are some that are given a devastating diagnosis and have to take expensive medications to maintain their health. No matter the cause for struggle, Medicare beneficiaries that need help often don’t know of all the places they can receive help.

Most Medicare beneficiaries don’t realize they can go to their state to find help paying for their medications. There are some states that have created a state pharmaceutical assistance program that will help residents that are struggling. Many of these programs have different benefits and eligibility requirements. Those that qualify for and receive these benefits are often surprised at the relief they get from the benefits.

Texas is one of the states that provide state pharmaceutical assistance programs to their residents.

Texas Kidney Health Care Program (KHC)

The Texas Kidney Health Care Program is a program that is available to Texas residents. It is a specialized program that not everyone will qualify for. For more information, residents of Texas can call 800-222-3986 or 512-776-7150.

Eligibility Requirements

To be eligible for this program, the following eligibility requirements have to be met:

·         Must be a Texas resident

·         Must be diagnosed with End Stage Renal Disease (ESRD) from a licensed doctor

·         Adjusted gross income must be at or below $60,000 annually

·         Must meet Medicare’s definition of ESRD

·         Must currently be receiving dialysis treatments or has received a kidney transplant

·         Must not be getting Medicaid assistance with medical, drugs or travel benefits

Who to Contact

Those that are interested in the program and would like to apply, contact:

Kidney Health Care Program

Department of State health Services, MC 1938

Po Box 149347

Austin, TX. 78714

Program Benefits

Those that are eligible and approved for this program will receive help with:

·         Their prescription drug copayments

·         Coordination of premium and benefits reimbursements

·         Coinsurance for immunosuppressive drugs that are under the Medicare Part B formulary

·         Limited reimbursement for traveling

·         Limited reimbursement for other medical expenses

*other benefits will have to be discussed with a program specialist

Texas HIV State Pharmacy Assistance Program

The Texas HIV State Pharmacy Assistance Program is a program designed to help those that meet the criteria. Those that are interested in the program should call 800-255-1090 ext. 3004.

Eligibility Requirements

Those that are interested in the program should know the eligibility requirements.

·         Must be diagnosed as HIV positive and their CD4 count and viral load must be on file with a licensed doctor

·         Must be a Texas resident

·         Adjusted gross income must be less than 200% of the Federal Poverty Level

·         Must be eligible for Medicare but nothing else

·         Must be enrolled in a Medicare Part D prescription drug plan

·         Must apply for and be denied enrollment into the Low Income Subsidy Program offered by the Social Security Administration (the denial letter will be required upon application)

Who to Contact

Those that meet the eligibility requirements and want to apply should contact:

ATTN: MSJA-MC 1873

Po Box 149347

Austin, TX. 78714

Benefits of the Program

The program will help cover most or all out of pocket expenses for medications for beneficiaries. These expenses include: the deductible, copayments, coinsurance and negotiated medication prices during the coverage gap. The medications that are covered should be covered under the Medicare Part D prescription drug plan formulary. This program does not pay the cost of Medicare Part D premiums. Those that are approved for the program will be eligible for renewal every 2 years.

While Texas is a state that provides 2 state pharmaceutical assistance programs, not everyone will be approved. Those that are not approved and still need help should contact the Social Security Administration to apply for the Low Income Subsidy Program.

Mar. 1 14'
tedbaxt your´╗┐ thoughts are coroled and your ratios are not accurate. Come back to me in three years when your parents are eating dogfood because their . Corporate Inefficiency???? Have you been to a Medicare only Clinic? Please .Please get a real education on the ramifications of socialized medicine before formulating adhoc opinion because of something someone TOLD you .
May. 26 14'

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