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Frequently Asked Questions

 
Frequently Asked Questions (FAQ) for Eligible Individuals
(Does not apply to Groups)
  8/7/2013 Revision
(For questions re: Medicare Part D, see page 3 and 4)
 
To Qualify for this program you must:
  • Be an Oregon resident who is uninsured or underinsured for prescription drug coverage.
  • Each individual must apply, including children
  • Enrollment in the Oregon Health Plan will NOT disqualify an individual.
 
Braille, or large print
  • Call Betty Wilton at 1-503-945-7834 or toll free (1-888-411-OPDP) for an alternate format.
 
Am I an Oregon resident?
            You are an Oregon resident if you have an Oregon address.
 
When does coverage start?
            Coverage starts as soon as you receive your I.D. Card.  
 
How long should it take to receive an I.D. card?
            You should receive an I.D. card within 7 business days of applying.  If you do not receive a card within that timeframe, call 1-800-913-4284.  
 
What pharmacy will I go to?
           The pharmacies are listed on this website under "Find a Pharmacy". You can also ask the pharmacy that you usually do business with if they are part of the OPDP network.
 
Are all my prescriptions covered?
            All FDA approved prescriptions prescribed by a licensed clinician are eligible for a discount.  This program does not give discounts for over-the-counter drugs, which are drugs you can purchase without a prescription.
 
Will this program cost me anything to join?
            There is no enrollment fee for enrolling in this program.  Should a nominal fee ever become necessary you will have no obligation to remain in the program.
 
I went to the pharmacy and my old discount card gave me a better discount than the OPDP card!
            We expect that to happen sometimes because most of the discount cards previously issued are sponsored by a specific pharmaceutical manufacturer, so their drugs may receive a greater discount.  However those same manufacturer discount cards won’t offer that good discount on other manufacturer’s drugs.  OPDP discounts are across the board, so keep the card for new prescriptions you might have.  It does not cost the pharmacist anything to get an estimate of the cost of an Rx through the OPDP so he can tell you before you purchase the prescription what the cost will be.
 
            Also remember that the greatest discounts through OPDP will be on generic drugs!
 
How do I find out if I could get a cheaper drug?
            Ask your physician or pharmacist if there is a generic or equivalent drug that may be cheaper than the drug you are prescribed?   Or look up drug costs on this website under "Look Up Drug Cost".
 
How much of a discount will I receive?
            Discounts will vary depending on whether a drug is generic or brand.  The greatest discounts are on generics and they can be as high as 80%!  The average discount is probably about 50%
 
What is a brand Rx or a generic Rx?
            Brand drugs are still on patent so they are only manufactured by one company.   Because there is no competition, these are the most expensive drugs.
 
            Generic drugs are made when a drug comes off of patent.  Several manufacturers can now make the drug so competition drives the cost down.  The FDA finds generics as safe as brand name drugs.  Also, evidence-based research has shown that higher cost brand drugs are NO MORE effective than lower cost alternatives.
 
APPLICATIONS
 
Does my spouse enroll separately?
            Yes, each person, including children, must enroll separately so each has a member number.
 
How do I enroll?
Call 1-800-913-4146.  For those who like to get on-line, they can enroll on the OPDP website: www.opdp.org 
 
Where do I get applications in other languages?
A Spanish, Russian and Vietnamese applications are available on-line at www.opdp.org
 
More Information?
 
Where do I find information about different prescription drug assistance programs?
            AARP - www.aarp.org/or (1-866-554-5360)
            Northwest Senior & Disability Services - www.nwsds.org (503-304-3400)
Senior Health Insurance Benefit Assistance (SHIBA) -  http://www.oregon.gov/dcbs/insurance/SHIBA/Pages/shiba.aspx
(800) 722-4134   
  
 
Where do I find information about evidence-based research on prescription drugs?
            AARP - www.aarp.org/or
State of Oregon Drug Review website: www.oregonrx.org
OHSU Center for Evidence-based Policy - http://www.ohsu.edu/drugeffectiveness/
 
 
Frequently Asked Questions about OPDP and
Medicare Part D Prescription Drug Coverage
 
If I enroll in Medicare Part D drug coverage why would I want to continue to use my OPDP discount card?
            The OPDP discount card may give you a better discount than your Plan gives you when you are paying 100% of the drug cost.  You will pay 50% of name brands and 93% of generics.  this will change every year until 2020 during the “gap in coverage”.  This gap happens when individual’s prescription drug expenses are between $2,840 to $6,447.50 (2011) in a given year and they are responsible for 100% of their drug costs.
 
If I am enrolled in Medicare Part D drug coverage and I use my OPDP discount card why do I have to send my receipt to my Part D Health Plan?
            If you want your OPDP expenses to apply towards your Medicare Part D costs, you must send your receipt to your Medicare Plan.  Right now, the only way to get this information to your Plan is to send it in by mail.    If that changes we will notify you.  In the meantime it is very important to send the paper receipt to your Plan and notify them that it needs to be credited toward your Medicare deductible and out–of-pocket expense.
 
What if I am enrolled in a Medicare Part D Plan and I want to use my OPDP discount card on a drug not covered by my Medicare Plan drug list?
            If the prescription drug is not on your Medicare Plan’s drug list, it cannot be counted toward your out-of-pocket expenses.  However, every Medicare Plan has an exception and appeal process that you can follow to ask the Plan to pay for drugs that are not on their list.  If the Plan approves your exception, your drug costs can count toward your Medicare deductible.
 
What if I am enrolled in a Medicare Part D Plan and I want to go to a pharmacy that is not on that Plan’s network but it is on the OPDP network?
            You may go to a pharmacy on the OPDP plan and use your discount card.  However, you should check with your Medicare Plan if you intend to use a pharmacy not on their list to make sure they will honor the receipt for your prescription as Part D expense.
 
I’m confused and don’t know whether to join Medicare Part D or not, what should I do?
            You can call 1-800-Medicare (1-800-633-4227) or your Medicare health plan for questions about your Medicare options.  You can also call the Senior Health Insurance Benefit Assistance (SHIBA) program at 1-800-722-4134 for assistance.
 
I don’t want to sign up for Medicare Part D, can I stay on the OPDP?
            You may remain an OPDP member and use your card for discounts at OPDP pharmacies.  However, you need to know that individuals who are eligible for Medicare Part D who choose not to enroll by May 15, 2006 will have a 1% per month penalty applied to their premium when they do enroll.  In other words, if you choose to enroll a year later, your premium will be 12% higher.
 
 
Contact Info:
Program Manager: Betty Wilton, 503-945-7834
Toll Free at 1-888-411-OPDP
Email: Betty.Wilton@state.or.us