Best Available Evidence of Low Income Subsidy for Prescription Drugs

You may apply to Medicare for Extra Financial 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 a LIS Level.

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 prescriptions.

If you believe you have qualified for Extra Help and you believe that you are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, our plan has established a process that allows you to either request assistance in obtaining evidence of your proper co-payment level, or, if you already have the evidence, to 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 send or fax a copy of the letter that Medicare sent to you telling you your LIS Level.

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 Health Plan, 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 Medicaid during a month after June of the previous calendar year:

  • A copy of your Medicaid card that includes your name and eligibility date
  • A copy of a State document that confirms active Medicaid
  • A print-out from the State electronic enrollment file showing Medicaid status
  • A screen print from the State’s Medicaid system showing Medicaid status
  • Other documentation, such as a copy of your SSA award letter, provided by the State showing your 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. Any document you submit must show that you were eligible for Medicaid during a month after June of the previous calendar year:

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

Click Here To View the Brand New Day Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs

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:

866-255-4795 or TTY 866-321-5955
8:00 a.m. to 8:00 p.m. Monday through Friday
(and weekends from October 1st through February 14th.)

For additional information about Best Available Evidence, click on the following link, which will take you to the Medicare website for Best Available Evidence: http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/index.html?redirect=/PrescriptionDrugCovContra/17_Best_Available_Evidence_Policy.asp

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