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Chronic Neuroimmune Diseases
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Last updated December 18, 2009

What does this mean?
For documented Medicare recipients, the Medi-Cal pharmacy can only charge a price that does not exceed what Medi-Cal would reimburse the pharmacy for the same prescription, plus a small processing fee ($0.15 per prescription). "Prescription" means the for the same drug, manufacturer, dose and quantity.

There are 5,000 participating pharmacies in California, so it should not be difficult to find one in your area. To find out if your regular pharmacy a Medi-Cal program participating pharmacy, look for be a decal on the door. If there isn't one, just ask the pharmacist or pharmacy clerks.

Another way to locate local Medi-Cal participating pharmacies is to contact the Health Insurance Counseling and Advocacy Program (HICAP) office and ask for the names of pharmacies in your area; call them toll-free at 1-800-434-0222

How does the program work?
At the time you present your prescription to be filled, present your Medicare card and ask them to please notate your file that you are a Medicare recipient and that you want to get Medi-Cal pricing for your prescriptions.

If the pharmacist or pharmacy clerk does not know what you are talking about, refer them to the California State Department of Health Services who administers the Medi-Cal program or to Sen. Speier's office, or print out a copy the DHS bulletin for them.

So, who pays for my prescriptions?
YOU are still responsible for paying for your prescriptions. You are just going to be paying the Medi-Cal pricing rather than the price you would have paid before this program went into affect.

Is it for all drugs?
It is for all prescription drugs that are covered under Medi-cal and for which you would have to pay out-of-pocket.

The most common 200 drugs filled by Medi-Cal pharmacies - and the per pill/tablet price - can be viewed online.

If the drug you are trying to price isn't on that regularly updated list, then you may call the California Department of Health Services's Medi-Cal Policy office at (916) 552-9714 (note: this is not a toll-free number) message line, or email them at SB393RX@dhs.ca.gov, and give them the following information:

• name of the drug
• the strength
• the quantity
• retail price

If you don't know the retail price, you can ask your regular pharmacist, or look the drug up on one of the online pharmacies, such as Drugstore.com.

What if I'm on Medicare but also have drug coverage under an insurance plan?
If your insurance plan coverage means that you are paying only a low co-payment for your prescriptions, then there is nothing to be gained from using this Medi-Cal pricing program. However, if you exceed your drug plan's annual benefit limit and have to pay for your prescriptions out-of-pocket until your new benefit period starts, then using this Medi-cal pricing program will help reduce your drug expenses until the new benefit period starts.

What about all the supplements and other over-the-counter things I have to use - are they covered?
No, only prescription drugs. Just because your doctor has told you to take something, if does not require a prescription to purchase it, it is not covered under this Medi-Cal pricing program.

Is this a permanent program?
As enacted, this program will be in existence until January 1, 2003. If changes to the Medicare reimbursement program result in Medicare covering prescription drugs before then, or any other legislation is enacted to provide such a benefit to Medicare recipients, then the continuation of this Medi-Cal pricing program will be re-evaluated.

2004 Update: Since the Medicare Prescription Drug program has not formally begun, the SB 393 program is still in effect.

Related Sites

Sen. Jackie Speier (D-San Francisco/San Mateo)

California Health Services

Full Text of SB 393

Medicare Prescription Drug Discount Price List (The Top 50 Medi-Cal Drugs, with Formulary)

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