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If a patient has Medicare Part D are you allowed to bill a free drug coupon the pays for the entire cost of the prescription?
Medicare and Drug coupons
- Thread starter TheDude559
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I always read the coupon. I believe if it a free one then it doesn't matter. But if it a pure discount billed with primary insurance then 99 if not 100% say they will not be eligible if they have Medicare, Medicaid, Tricare etc.
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Traditionally, yes. Off the top of my head, the Combivent Respimat coupon card that doctors give out has a small keychain card sized breakoff that is used specifically for medicare patients.
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Actually, I believe the answer is no.
The anti-kickback statute applies if the service or item is "reimbursable" by a federal program (e.g. VA, DOD, CMS, Tricare). It doesn't specify that the service/item is actually partially paid by medicare at that time. Since the point of a "free-trial" is to get the patient to continue with a drug that would be subsequently be paid for by Medicare the statute would apply.
Exceptions are made when the company pays for all of the cost of the drug throughout treatment (or only within the doughnut hole). These are usually Patient Assistance Programs. I don't believe the one time use cards ever count.
Most of the free drug coupons state if Medicare patient's are eligible. I would advise you always follow the instructions on the card, or call the company.
The anti-kickback statute applies if the service or item is "reimbursable" by a federal program (e.g. VA, DOD, CMS, Tricare). It doesn't specify that the service/item is actually partially paid by medicare at that time. Since the point of a "free-trial" is to get the patient to continue with a drug that would be subsequently be paid for by Medicare the statute would apply.
Exceptions are made when the company pays for all of the cost of the drug throughout treatment (or only within the doughnut hole). These are usually Patient Assistance Programs. I don't believe the one time use cards ever count.
Most of the free drug coupons state if Medicare patient's are eligible. I would advise you always follow the instructions on the card, or call the company.
