Form Il-1363 - Application For Circuit Breaker Grant, License Plate Discount, And Optional Help Paying For Drugs (Pharmaceutical Assistance Or Seniorcare) - 2004 Page 6
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20Questions about help paying for drugs
Who may get Pharmaceutical
What drugs are covered?
Assistance or SeniorCare?
Almost all prescription drugs are covered by
SeniorCare. Pharmaceutical Assistance covers
A claimant or c laimant’s spouse who meets the
prescription drugs used in the treatment of
requirements on Page 2 (“Who should apply?”)
certain diseases (see Pages 8 and 9).
and applies may get Pharmaceutical
Assistance or SeniorCare depending on your
Both programs cover both brand name and
application information.
generic drugs and use a preferred drug list
(PDL). The preferred drug list is a list of some
A qualified additional resident who meets the
age requirements on Page 2 may qualify for
types of drugs, but not all, that are covered by
Pharmaceutical Assistance.
your card.
Each person approved for Pharmaceutical
A drug listed as “preferred” on the PDL can be
Assistance or SeniorCare will get a card under
obtained at the pharmacy without any
his or her own name.
additional approval required. A drug that is
listed as “non-preferred” requires an extra step
What if I have other insurance or
called prior approval before the program will
Medicare Part B that will pay for my
pay for it.
drugs?
Your pharmacy or doctor’s office may call to
request prior approval of a non-preferred drug.
Even if you have other insurance, you may use
If the prior approval request is approved, your
Pharmaceutical Assistance or SeniorCare to
pharmacy will be able to fill your prescription
get your covered drugs. We will bill your other
within 24 hours. If the prior approval is denied,
insurance for the cost of the drugs we paid on
your pharmacy or doctor will receive a letter in
your behalf.
the mail informing them of the denial. You have
If you have the MediPlan card, you are not
the right to appeal the denial of a prior
eligible for Pharmaceutical Assistance or
approval.
SeniorCare. If you are on Spenddown, you can
PDLs for each program are available through
use Pharmaceutical Assistance or SeniorCare
our web site at Your
until you receive a MediPlan card.
doctor can use your program’s PDL to
If you have a SeniorCare drug coverage
prescribe a preferred product if it is medically
card and you have other insurance that pays for
appropriate.
your drugs, you may choose to get the
SeniorCare rebate instead of using the
How can I get the most benefit
SeniorCare card. See Page 10, “Questions
from these programs?
about the SeniorCare rebate” for more
File as soon as you have the information you
information.
need to complete Form IL-1363.
What if I have a drug discount card?
File on the internet if you qualify. See Page 3.
You may use your discount to purchase
Ask your doctor to prescribe a generic drug
medicine that is not covered by Pharmaceutical
for you. Generic drugs are usually less
Assistance or SeniorCare.
expensive than brand name drugs.When a
generic drug is not available, ask your doctor
to prescribe a preferred product from the
preferred drug list if medically appropriate.
Check with your pharmacist to make sure
your coverage will be honored.
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Apply every year
Renew by March 31
IL-1363 instructions (R-12/04)
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