Get to know Missouri’s SenioRx Program

by Jim Whorton

The cost of prescription drugs is rising at a tremendous rate, and senior citizens are particularly at risk. The new Missouri SenioRx program is being implemented by the state of Missouri to assist seniors in handling these rapidly rising costs. Eligible seniors will be able to start using their Missouri SenioRx program cards at participating pharmacies beginning July 1, 2002.

In order to determine your eligibility, you must obtain and complete an application form which must be postmarked no later than May 30, 2002. I’m trying to make sure these forms are readily available by working with area senior centers, tax preparers, local libraries, etc. Applications will be received and processed by a third party administrator. A company called ACS State Healthcare has been awarded a contract by the State of Missouri to administer the program.

General Eligibility requirements are: at least 65 years of age, a resident of the State of Missouri for the past 12 months, no access to health insurance with prescription drug coverage for 6 months, not receiving Medicaid benefits, have an income of $17,000 or below if an individual or $23,000 or below if a couple. (Those turning 65 during the year, or whose income drops into eligible levels will be allowed to come into the program through “Qualifying Event” provisions).

General Benefits are as follows: Two levels of annual deductibles and enrollment fees will apply, but specific fees and deductibles may be changed by the Commission, depending on the number of enrollees. For individuals with income at $12,000 or below and for couples with income at $17,000 or below, the Enrollment Fee is estimated to be $25 with a deductible of approximately $250. For individuals with income at $17,000 or below and for couples with income at $23,000 or below, the Enrollment Fee is estimated to be $35 with a deductible of approximately $500.

In addition, members are required to pay a 40% coinsurance on each formulary drug. If a member selects a brand name drug when a generic equivalent is available, they are responsible for paying the generic coinsurance plus the cost difference between the brand name and generic drug. There will be an annual benefit cap of $5,000 per enrollee.

After May 30th, at the close of the application for enrollment period, the Commission will evaluate total program enrollment and define the exact plan benefits to ensure that the program stays within budget mandates. At this point, approved applicants will receive notice of the benefits they qualify for, and will be requested to remit their enrollment fee. Once this fee is received, they will be mailed Member Welcome packets, including their ID card, instructions on its use, information on covered drugs, and information on participating pharmacies.

For additional details you may contact the Commission for the Missouri Senior Rx Program within the Department of Health and Senior Services at 1-866-256-3937 or visit the website at www.dhss.state.mo.us/Rx/.