On January 1, 2006, for the first time in the program’s history, Medicare began providing prescription drug coverage. Enrollment in the new prescription drug benefit, also known as Medicare Part D, is voluntary, and the open enrollment period will continue until May 15, 2006.

“For people with ALS who are eligible for Medicare, the new benefit may provide significant savings over their current drug costs, especially if they currently do not have coverage,” said Pat Wildman, ALSA’s Director of Federal Advocacy Outreach. “People with limited resources may realize even greater savings as they may qualify for additional assistance from Medicare including reduced monthly premiums and low co-payments."

ALSA strongly supported the drug benefit leading up to Congressional passage in 2003 and since that time the Advocacy Department has worked closely with the Centers for Medicare and Medicaid Services to make sure Rilutek©, the only drug approved by the Food and Drug Administration to treat ALS, would be covered by Medicare prescription drug plans offered under the benefit. Following ALSA’s advocacy efforts, the drug was included on an example of a model list that prescription drug plans can follow when creating their formularies, or lists of covered drugs.

“While the benefit may provide savings, there are many options available to PALS, including keeping their current drug coverage,” Wildman said. “So it is important that PALS and their caregivers and families take the time to review their options and make the choices that are most appropriate for their specific needs.”

Wildman said that if someone currently has prescription coverage, they should compare that coverage with the coverage that is available through Medicare before deciding to enroll. However, those who do not enroll during the initial enrollment period (November 15, 2005-May 15, 2006) may have to pay a penalty (1 percent premium increase for each month a person waited to enroll). For example, enrolling six months late would increase monthly premiums by 6 percent. Enrolling 2-1/2 years late would increase monthly premiums by 30 percent. These premium increases would be permanent and would continue for as long as someone is enrolled in the prescription drug benefit.

However, if a person’s current prescription coverage is deemed to be equal to or better than Medicare’s (referred to as “creditable” coverage), they will not have to pay a penalty if they choose not to enroll in the Medicare prescription drug benefit at this time. In fact, health plans and employers providing coverage were required to provide notice of “creditable” coverage to people by November 15, 2005 if their coverage was equal to or better than Medicare. People who received this notice should keep it on file. And if they didn’t receive it, or misplaced it, they have a right to request it from their health plan.

ALSA’s Advocacy Department has created a special page on The Association’s website at www.alsa.org that provides a wealth of information about the drug benefit. Located on ALSA’s home page under Public Policy, the page includes such sections as: the basics of the plan, prescription drug toolkits, the availability of regional drug plans, and selecting a prescription drug plan. There also are sections on frequently asked questions and answers, important dates and deadlines, Medicare training and assistance, and publications and fact sheets.

For additional information, call Pat Wildman toll-free at (877) 444-ALSA or send him an e-mail at pwildman@alsa-national.org.