April 28, 2006: Dual Eligibles Sometimes Mis-Charged a High Co-Pay
For some dual eligibles, the drug plan's computer is not recognizing their status as a dual eligible. This has been particularly true for the Horizon PDP (Rx Plan 1 or 2), but also has happened with others. As a result, some pharmacists are telling some dual eligibles that they must pay a high co-payment (the same as non-dual-eligibles) in order to receive their prescription drugs. While NJ Medicaid covers the normal $1 or $3 co-pay, it will not pay these higher co-pays.
What can you do if this happens?
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At the pharmacy counter, call, or ask the pharmacist to call the Centers for Medicare and Medicaid Services (CMS)- 212-616-2222. (NOTE: This is not a toll-free phone number.) This phone number is answered Monday thru Friday from 8:30 am to 5:00 pm.
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Ask CMS to initiate a 3-way call between CMS, the pharmacist, and the Medicare PDP to fix the computer error immediately. This 3-way conference call process can only happen during regular business hours.
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If the problem of high co-payments occurs during non-business hours, consumers (or caregivers) should call the hotline as soon as possible on the next business day.
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