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Extra Help to Pay for Prescription Drugs

Information Last Updated: 11/13/2018

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How to apply for Extra Help with your prescription drug costs.

 

You may apply to Medicare for Extra Help with your prescription drug costs. Medicare will review your income level and if you qualify they will give you financial help. They will send you a letter telling you the level of help you qualify for.

They call this financial help a Low Income Subsidy or LIS.

When you go to the pharmacy they will be able to see your LIS level and will know how much to charge you for your prescription drugs.

  • If you believe you have qualified for Extra Help and are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, Brand New Day has established a process that allows you to:
    • request assistance in obtaining evidence of your proper co-payment level or
    • if you already have the evidence, please provide this evidence to us.
  • If you believe Brand New Day or your pharmacy doesn’t have the right LIS Level for you, you can contact us and send a copy of the letter that Medicare sent, telling you your LIS Level.

Processing your Evidence for LIS

When we receive your evidence, it is considered the “Best Available Evidence” and we will enter that information into our system and the pharmacy’s system to correct your LIS level. This will help the pharmacy to charge the right amount for your prescriptions.

We can accept the following documents as evidence of your proper co-payment level. These documents can be provided by you as a member of Brand New Day, by your pharmacist, advocate, representative, family member or other individual acting on your behalf, by mail or fax. Any document you submit must show that you were eligible for Medi-Cal Medicaid during a month after June of the previous calendar year:

  • A copy of your Medi-Cal (Medicaid) card that includes your name and eligibility date
  • A copy of a State document that confirms active Medi-Cal (Medicaid)
  • A print-out from the State electronic enrollment file showing Medi-Cal (Medicaid) status
  • A screen print from the State’s Medicaid system showing Medi-Cal (Medicaid) status
  • Other documentation, such as a copy of your Social Security Administration (SSA) award letter, provided by the State showing your Medi-Cal (Medicaid) status
  • A Supplemental Security Income (SSI) “Notice of Award” with an effective date
  • An “Important Information” letter from SSA confirming that you are automatically eligible for extra help

The following documents are required if you are Institutionalized (long-term care or nursing home). Any document you submit must show that you were eligible for Medi-Cal (Medicaid) during a month after June of the previous calendar year:

  • Remittance from the long term care facility showing Medi-Cal (Medicaid) payment for a full calendar month
  • A copy of a State document that confirms Medi-Cal (Medicaid) payment on your behalf to the long term care facility for a full calendar month
  • A screen print from the State’s Medi-Cal (Medicaid) systems showing your institutionalized status, based on at least a full calendar month’s stay for Medicaid payment purposes

If you receive Extra Help from Medicare to help pay for your Prescription Drug costs, you can view the Brand New Day Monthly Plan Premium for People who get Extra Help by clicking here: ( 2018 )  ( 2019 )

If you feel you were already charged incorrectly at the pharmacy, you can file an appeal to request reconsideration. If you would like to file an appeal, please call Brand New Day Customer Service at:
Call: 1-866-255-4795, TTY 711
Hours of Operation:

Year Round:
Monday - Friday 8am - 8pm

October 1 - March 31:
Monday - Sunday 8am - 8pm

For additional information about Best Available Evidence, click on the following link, which will take you to the Medicare website for Best Available Evidence:

Https://www.cms.gov/Medicare/Prescription-Drug-Coverages/PrescriptionDrugCovContra/Best_Available_Evidence_Policy.html