|spend down AND MEDICARE TRANSITIONAL ASSISTANCE|
dated May 11, 2004 regarding the Medicare Prescription Drug Discount Card and
Transitional Assistance, we stated that the Centers for Medicare and Medicaid
Services (CMS) had not yet given clearance as to whether the portion of
prescription drugs paid by the $600 credit was to be allowed toward meeting
spend down. CMS has now given this clearance.
The portion of prescription drug cost paid for by the Medicare $600 credit is NOT allowed to meet spend down. CMS has indicated that we must follow normal spend down rules, that there is no special provision for drug costs paid for by this credit.
Under normal spend down policy, the amount of a prescription drug allowed to meet spend down is the amount of liability the person incurs. Any portion of a prescription drug paid by Medicare Transitional Assistance is not an allowable expense for meeting spend down. Thus, if the person is to pay only a 5% or 10% coinsurance for a particular prescription, only the 5% or 10% coinsurance is allowed towards meeting spend down. Also any discount provided by the card sponsor for a particular drug is not allowable as an expense.