TRIP FUNDING IN JEOPARDY!
Your help is needed! Recently formed "legislative working groups" began meeting in Springfield this week, and what we have learned so far is that the Rauner administration has already put forth proposals to fill the $6 billion hole in the 2016 state budget. Of the many reforms he has put forth, his administration has stated they want to cut the state funding to TRIP.
State funding into TRIP is vital to us, without the state's $95 million assistance to the program insurance premiums will rise drastically.
Please contact your state representatives and senators by clicking the link below and let them know how cuts to TRIP funding will affect you.
Take Action on TRIP funding
PRESCRIPTION DRUG COVERAGE GAP
The following is an explanation from United Health Care and the State of Illinois Department of Central Management Services regarding the cost of prescriptions once a member enters the "coverage gap" and "catastrophic" coverage.
When a member enters the prescription Medicare Part D 'coverage gap' (the amount between $2,850 and $4,550) the amounts that the member pays for their prescriptions is still the copayment amount; however, the amount the member pays (i.e., the copayment) is added to any manufacturer's discount given to the plan for brand name drugs the member filled. The manufacturer's discount is usually 50% of the drug's retail value and is given to the plan (UHC/OptumRX) for the cost of the drug. It is this discount that is also added to the member's copayment that can throw them over the $4,550 amount into the 'catastrophic' coverage. Once in the catastrophic level, the member will usually end up paying 5% of the cost of the drug. All of these costs are indicated on the Explanation of Benefits (EOB) from UHC. The member will get two separate EOBs, one for medical services and one for prescriptions. The member will only receive an EOB if they had medical or prescription expenses during the month. The prescription EOB will list the name of the drug, the date it was filled, the pharmacy that filled the prescription, the tier the drug is in, what the plan paid for the drug, what the member paid for the drug (copayment) and 'other' payments, which are the manufacturer's discounts. Please see the following example:
Humera (brand name drug was discounted 50%; total cost of the drug is not on the EOB, but in this case was $5,130.36)
Plan Paid - $2,735.09
Member Paid - $50.00 (copayment)
Discount - $2,345.27
The Department of Central Management Services continues to work with United Health Care (UHC) to negotiate a fair alternative. IRTA will continue to keep our members updated on any future changes.