Posts Tagged ‘SFAN’

Update from Tim – SFAN meeting;

I really want to thank those you who came to the SFAN meeting and hope we will have better information soon. I apologize if any one was uncomfortable introducing themself. That is regular for SFAN meetings, but we usually do not do that at Community Meetings. Please be assured that although the meeting is recorded, it is just for very basic minutes and your name will not be posted anywhere. We are in such need for Congress to approve additional funding, but we have to keep asking for it and demanding it.
For those that came, I’m sorry you had to listen to me again about Medicare part D and ADAP. I had not planned to do a presentation but as the day went on yesterday, there seemed to be very little about it so I put a Powerpoint together for a handout just in case. I hope the information I gave was informative, despite being repetitive of what has already been posted. I have had the most frustrating week dealing with Tallahassee trying to get them to see how important it is for ADAP to cover Medicare Part D clients in the Catastrophic Phase.
Due to the huge budget shortfall, I was repeatedly told it was either give them just help in the Doughnut Hole or no help at all. I will continue to fight for extra money from Washington and work with community organizations on ways we can keep patients from falling out of care due to unaffordable costs.
I find it very suprising that the Health Department says only 21 clients in Broward are Medicare + ADAP. That number seems very low to me since we had 8 at the meeting last night.
For those with ADAP, the change in eligiblity from 400% Poverty ($43,320) to 300% ($32,490) will not be the dreaded December 1,2011that was originally announced, but no earlier than February 1, 2011. This gives those affected clients time to enroll in Patient Assistance Programs. This number is 71 in Broward County. At least the Patient Assistance Programs for HIV medications are covering everyone. We are only aware of 1 person who was initally denied, but then received their medication on appeal. It’s important to know you have the right to appeal and for the HIV meds you should not have trouble obtaining them. Unfortunately, supportive medication Patient Assistance Programs are less generous and links those removed from ADAP are under the Meds Assistance tab from the Home Page. As a reminder, the Health Department Patient Assistance Progam Navigator who can help you with both original applications and appeals is William Patrick and his direct number is (954) 467-4700 extension 5666.
I hope there will be good turnout tonight at the Town Hall meeting at Hagen Park as their will be media there to cover it and represenation from government officials. Please hang in there, don’t give up, and try to become an Activist even if you are not directly impacted. Activism from large numbers is the only possibility of us getting the needed additional funding. Thanks again. Tim

Read Full Post »

From Tim:

I have been locked in a fierce battle for the Medicare Part D clients with ADAP regarding coverage once they reach Catastrophic. It seems as if I have lost. The answer I keep getting is that coverage for the “Doughnut Hole” is better than no coverage at all and that people with no other serious illness get assistance with their medication costs so they should be grateful they have not been cut entirely. Please get these clients to attend both the Tuesday SFAN meeting and the Wednesday Town Hall meeting as they really need for their voices to be heard. I have also been hit back with the idea that people chose not to vote on Election Day so we have to deal with the consequences. We desperately need Congress to provide additional funding and need to mobilize as a community.

Unless we can get them to change their mind, the rule is as follows for Medicare + ADAP:
1. Client must carefully pick a plan during the open enrollment plan which began today and runs through December 31, 2010 for plan to start on January 1, 2011.

2. They will be required to go to a retail pharmacy for their medications until they reach the Doughnut Hole. This will happen in January or February for most patients. They need to get the pharmacy to give them a print-out showing they have reached the Doughnut Hole and then they can briefly return to ADAP. ADAP will only assist them with HIV meds and Opportunistic Infection Drugs during this phase until the patient emerges from the Doughnut Hole and hits the “Catastrophic Phase.” Catastrophic occurs when the amount of True Out of Pocket Costs from the patient, ADAP and the 50% discount for Brand Name drugs provided by drug manufacturer’s reaches $4550. They are assuming that ADAP will only be assisting these clients for 2 months at most.

3. At this point, they will have to go back to retail pharmacy for remainder of year for ALL DRUGS and pay $2.50 generic, $6.30 brand, or 5% whichever is greater. For HIV drugs in particular it is going to be the 5% and can get really costly.

4. They need to work with their doctors to lower their costs, perhaps switching to low cost generics in any way possible to use the Walmart/Target $4 list, but ultimately their costs are going to increase A LOT. Some might want to join Medicare Advantage plans so they do not have to pay a premium. I have a feeling that Positive Healthcare Partners will be doing a big sell at the Town Hall meeting.

I know this is awful news, but I have fought this battle extremely hard without being able to win. I have given them specific examples yet I can get no one in power to see the harm this can cause. I have also been unsucessful in getting Ryan White Pharmacy to even consider helping those with Medicare Part D. I plan to keep fighting, but we really need to mobilize like we are back in the 1980’s again.

It is strongly encouraged that those who do not have many assets who may be above the 150% Federal Poverty Level ($16,245) apply for Extra Help at http://www.ssa.gov as they sometimes allow people with higher incomes on.

As far as those who are ADAP without Medicare, the change of reducing eligibility from 400% Poverty ($43,320) to 300% Poverty ($32,490) will not happen until February 1, 2011 instead of the December 1, 2010 we were dreading. If anyone in the group falls into this category, they need to meet with a Patient Assistance Program Navigator or their Case Manager to apply for Patient Assistance Programs as soon as possible. I have been told that these affected people “should” all be able to get all of their HIV medications from the Patient Asssistance Programs.

I hope you will post this or at least pass on to the group. If the SFAN meeting and the Town Hall meeting receive poor attendance, the will of Community Advocates will probably decrease.

I will assist any group member in any way that I can. Just ask.


Read Full Post »