Summary:
• State program helps low-income residents purchase prescription drugs.
• Most beneficiaries save more under SeniorCare than Medicare Part D.
• Obama administration has extended program through 2012.

Helen Patton Gray takes five different prescriptions retailing for more than $250 a month. She pays $55.

Photo by David Nevala

Helen Patton Gray takes five different prescriptions retailing for more than $250 a month. She pays $55.

Gray, 79, of Menasha, subscribes to SeniorCare, Wisconsin’s prescription drug program for low-income residents over 65. “If I had to pay full price for my prescriptions, I just wouldn’t be getting them,” she said.

Enacted in 2002 before the Medicare Part D program, SeniorCare provides prescription drugs for copayments of $5 for generic and $15 for brand-name drugs for qualified applicants. Participants pay an annual $30 enrollment fee.

“It is affordable, it is easy to apply for, and the state gets a good rebate from the pharmaceutical industry,” said D’Anna Bowman, AARP Wisconsin senior state director. “It’s just an incredible program.”

It’s a big hit in the state. A 2005 study for AARP found that for most users it was superior to Part D because of SeniorCare’s significantly lower out-of-pocket costs. Some 94 percent of SeniorCare enrollees would pay more if they were under Part D, the study found, and more than half have too much income to qualify for Part D’s low-income subsidy.

“It’s wonderful. It gives me peace of mind,” said Suzanne Hart, 74, of Beloit. Kay Jones, 86 another Beloit resident, added: “It’s a safety net for me.”

A Brandeis University study that looked at Wisconsin SeniorCare and a similar program in Illinois found that together they cut in half the percentage of people who had to go without necessities or skimp on prescribed drugs.

The federal government financed roughly 27 percent of SeniorCare last year; the state contributed about 30 percent, and another 43 percent came from drug industry rebates. In August, the Obama administration agreed to extend SeniorCare, which had been scheduled to expire at the end of the year, through 2012.

“SeniorCare not only gives our seniors the medications they need at a reasonable price, but it also saves Wisconsin taxpayers millions of dollars,” said Gov. Jim Doyle, D, in announcing the extension.

SeniorCare benefits are available to:

• Individuals with incomes below $17,328, or below $23,312 for couples, who don’t pay any deductible.

• Enrollees whose incomes range from $17,329 to $21,660 (individual) or $23,313 to $29,140 (couple), who pay a $500 deductible.

• Those with incomes from $21,661 to $25,992 (individual) or $29,141 to $34,968 (couple), who pay an $850 deductible.

• People with higher incomes, who can “spend down” their income by paying retail prices for drugs until they’re in the $850 deductible category.

SeniorCare’s current enrollment is just under 88,000, about 17,000 fewer than at its peak a few years ago. The Medicare Part D program had almost 141,800 Wisconsin enrollees as of February. Of those, about 27,000 are receiving some form of low-income subsidy.

The decline in SeniorCare enrollment doesn’t mean people are dissatisfied. For some people with very low income, Part D’s subsidies may be a better deal, Bowman said.

Karen Timberlake, secretary of the Wisconsin Department of Health Services, said some people may have been scared away when it appeared the Bush administration would not extend the program in 2007.

But it was extended—after Wisconsin’s entire congressional delegation gave it bipartisan support. That enthusiasm has continued; the delegation unanimously urged the Obama administration to keep it going.

Timberlake, Bowman and other SeniorCare advocates say the program is a good deal for the feds, saving money for the government as well as for prescription drug users. An AARP study calculated the federal government would have had to pay $25.6 million more a year to cover prescription drugs for low-income enrollees under Part D than it would under SeniorCare if the state program didn’t exist.

Some in Wisconsin hope that SeniorCare could become a model for Part D reform. They may be right: “It definitely has caught the attention of lots of folks outside of Wisconsin,” Health and Human Services Secretary Kathleen Sebelius told a U.S. Senate panel earlier this year.

Instructions on how to enroll in SeniorCare are available online or call the SeniorCare Customer Service Hotline at 1-800-657-2038 (voice) or 711 (TTY).

Erik Gunn is a writer and editor living in Racine, Wis.