Illinois Will See Cuts In State Cares Rx Program : July 22, 2011

Southwest Suburban News-Herald : By AMANDA DRAPIEWSKI July 22, 2011

Residents who are part of the Illinois Cares Rx program could see some cuts in their coverage.

On June 30, Gov. Pat Quinn signed several bills enacting a state budget for the fiscal year 2012.

These included Public Act 97-0074, the law that continues the Illinois Cares Rx (ICRx) program but with half the budget.

The good news is that the program will continue to provide assistance to more than 150,000 seniors and people with disabilities.

However, beginning Sept. 1, about 350,000 people now on the program will lose their benefits.

Those remaining in the program will see changes in the amount they pay for each prescription they fill (the co-pay).

The income limit to qualify for the program will be lowered to 200 percent of the Federal poverty level (FPL), which is $21,780 for an individual and $29,420 for a couple.

Residents over this limit will lose their ICRx benefits.

In a one-person household, the income limit before Sept. 1 has to be $27,610, and beginning Sept. 1, the income limit will be $21,780.

In a two-person household, the income limit before Sept. 1 has to be $36,635, and beginning Sept. 1, the income limit will be $29,420.

In a three-person household, the income limit before Sept. 1 has to be $45,657, and beginning Sept. 1, the income limit will be $37,060.

The “rebate” option is ending.

Residents who currently get a rebate check of $25 a month instead of ICRx benefits will receive their last check (for August) in September.

The co-pay amounts will increase.

The new law authorizes the Department of Healthcare and Family Services (HFS) to change the co-pays each year; an administrative rule with final changes is expected.

Although this is not final, the planned amounts for people with Medicare are:


• $5 generic;

• $15 preferred brands;

• $20 non-preferred brands;

• $15 speciality drugs; and,


• Twenty-five percent plus co-pay in the “donut hole.”

For those with a diagnosis of HIV or AIDS, the co-payments for drugs on the AIDS Drug Assistance Program formula will remain the same.

For people without Medicare, the co-pays will be $5 for generic and $15 for brands.

Barbara Otto, chief executive officer of the Health and Disability Advocate, said the program is designed to help seniors and people with disabilities pay for prescription drug assistance.

“The program is voluntary,” said Otto. “This (the program) mainly wraps around a senior’s Medicare Part D.”

For participants enrolled in Medicare Part D, Illinois Cares Rx helps lower the participants’ co-payments and cost-sharing. Illinois Cares Rx provides direct prescription drug coverage for participants who are not eligible for Medicare.

Illinois Cares Rx consists of two benefit levels: Illinois Cares Rx Plus and Illinois Cares Rx Basic.

Illinois Cares Rx Plus covers almost all prescription drugs.

Illinois Cares Rx Basic covers prescription drugs used in the treatment of Alzheimer’s disease, arthritis, cancer, diabetes, glaucoma, heart disease and its related conditions, lung disease and smoking-related illnesses, multiple sclerosis, osteoporosis, and Parkinson’s disease.

In order to qualify for Illinois Cares Rx, residents must be 16 years of age or older and have income at or below the income limits.

If residents are under age 65, they must be disabled to qualify for Illinois Cares Rx.

Residents will qualify if:


• They are under age 65 and do not have Medicare; or

• They are 65 years of age or older, do not have Medicare, and do not meet the citizenship requirements for Illinois Cares Rx Plus.


“The program provides a cushion for seniors so they don’t have to go without their prescriptions,” said Barbara Kancelbaum, who works for the Communications Department for the Health and Disability Advocates.

The Illinois Department on Aging’s Circuit Breaker program provides grants to senior citizens and persons with disabilities to help them reduce the impact of taxes and prescription medications on their lives.

When the costs of property taxes and prescription medicines begin to “overload,” seniors and persons with disabilities in this program receive help, just as a circuit breaker prevents overloads in an electrical system.

In past years, the Department on Aging has been able to issue Circuit Breaker grants at the maximum allowable amounts.

However, the state budget for fiscal year 2011 (July 1, 2010 to June 30, 2011) did not fund the Circuit Breaker program at those levels.

In order to continue to provide the Circuit Breaker grant benefit to older adults and persons with disabilities on and after July 1, the Department made the decision to cut each grant awarded in half.

This decision based on budgetary cutbacks cannot be appealed.