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Pennsylvania State Pharmacy Assistance Programs (SPAP)

Pharmaceutical Assistance Contract for the Elderly (PACE), Pennsylvania PACE Needs Enhancement Tier (PACENET), Special Pharmaceutical Benefits Program - HIV/AIDS, and Special Pharmaceutical Benefits Program - Mental Health




Pharmaceutical Assistance Contract for the Elderly (PACE)


Eligibility Requirements:
  • You must be a Pennsylvania resident for at least 90 days prior to the date of application and over the age of 65 years.
  • You cannot be enrolled in the Department of Public Welfare's Medicaid prescription benefit.
  • You must not be eligible for pharmaceutical benefits under medical assistance.
  • Your income for the year preceding your application must be less than $14,500 a year for a single person and less than $17,700 per year for a married person. Note that the income requirements for applying are based on your previous year's income.
Important Notes: If you are eligible for the PACE program, you must pay a $6 co-payment for generic drugs and $9 for each single-source brand name drug. These copayments are based on a 30-day supply.

PACE/PACENET benefits are considered "creditable coverage" which means that the benefits offered through this program are as good as or better than the prescription benefits offered through Medicare Part D. However, individuals are encouraged to be enrolled in PACE/PACENET and Part D together. By doing so, cardholders can potentially save even more money when buying their prescription medications.
Contact Information: Phone
(800) 225-7223
(717) 651-3600

Address
PACE/PACENET Program
P O Box 8806
Harrisburg, PA 17105
» Pharmaceutical Assistance Contract for the Elderly (PACE)



Pennsylvania PACE Needs Enhancement Tier (PACENET)


Eligibility Requirements: You must be a resident of PA for 90 consecutive prior to your application, be 65 years of age or older, with income from previous year between $14,501 to $23,500 if single and $17,701 and $31,500 if married. You cannot be enrolled in the Dept. of Welfare's Medicaid prescription benefit.
Important Notes: Effective January 1, 2014 PACENET cardholders not enrolled in a Part D Plan will pay a $35.50 premium at their pharmacy each month.
Income qualification is based on prior year's income and includes taxable and non-taxable sources. Assets and resources are not counted as income.

PACENET cardholders that do not enroll in a Part D plan will pay a nominal deductible each month at the pharmacy, which will be calculated through the cost of their medications. If the deductible is not met each month, it will accumulate. In addition, the individual will pay no more than $8 for each generic prescription medication and no more than $15 for each brand name.

PACENET cardholders enrolled in one of the program’s partner Part D plans will pay the Part D premium at the pharmacy each month, which will be calculated through the cost of the medications. PACENET cardholders enrolled in a Part D plan that is not one of the program’s partner plans will pay the Part D premium directly to the Part D plan. In addition, they will pay no more than the PACENET co-payments of $8 for each generic prescription medication and $15 for each brand name.

PACENET cardholders enrolled in one of the program’s partner Part D plans will have to pay the Part D plan’s premium at the pharmacy but will no longer have to pay the PACENET deductible. You will never be charged more than the cost of your medication at one time. Therefore, if the cost of your medication is less than the amount of premium you owe, you only pay the cost of the medication and the remaining amount of the premium you owe will be carried over until you need another medication filled (that same month or the next month).

PACE/PACENET WORKS WITH:
MEDICARE PART D PLANS
RETIREE/UNION COVERAGE
EMPLOYER PLANS
VETERANS’ BENEFITS

PACE/PACENET benefits are considered "creditable coverage" which means that the benefits offered through this program are as good as or better than the prescription benefits offered through Medicare Part D. However, it is encouraged individuals to be enrolled in PACE/PACENET and Part D together. By doing so, cardholders can potentially save even more money when buying their prescription medications, and it helps the PACE Program save money, too!
Contact Information: Phone
(800) 225-7223
(717) 651-3600

Address
PACENET Program
P.O. Box 8806
Harrisburg, PA 17105
» Pennsylvania PACE Needs Enhancement Tier (PACENET)



Special Pharmaceutical Benefits Program - HIV/AIDS


Eligibility Requirements: Special Pharmaceutical Benefits Program - HIV/AIDS Provides pharmaceutical assistance and specific lab services to low to moderate income individuals living with a diagnosis of HIV/AIDS who are not eligible for pharmacy services under the Medical Assistance (MA) Program.

New Enrollment
  • Income Limits: Individuals - $37,642.90 gross income per year Families - $37,642.90 gross income per year, plus an allowance of $13,345.20 for each additional family member. (Example: family of two $50,988.10 combined gross; family of three $64,333.30 combined gross; etc.)
  • Residence: Must be a Pennsylvania resident.
  • Medical Need: Your prescribing clinician must sign and date Section 12. You must submit a copy of at least one HIV/AIDS specific antiretroviral medication.
  • Resources: Resources such as real property etc. are exempt.
Re-Enrollment
  • >Income Limits: Individuals - $55,850.00 gross income per year Families - $55,850.00 gross income per year, plus an allowance of $19,800.00 for each additional family member. (Example: family of two $75,650.00 combined gross; family of three $95,450.00 combined gross; etc.)
  • Residence: Must be a Pennsylvania resident living in Pennsylvania and not institutionalized.
  • Medical Need: Not required, this information already on record.
  • Resources: Resources such as real property etc. are exempt.
Important Notes: SPBP HIV/AIDS is the payer of last resort and third party resources must be used before payment is made by the program.

ALL INFORMATION SUPPLIED TO THE SPBP COORDINATOR IS STRICTLY CONFIDENTIAL

The SPBP requires annual recertification. Clients will be notified by mail and asked to verify information.

If you need help completing this application, please call 1-800-922-9384, or send an email to SPBP@state.pa.us.
Contact Information: Phone
(800) 922-9384

Address
Department of Public Welfare
Special Pharmaceutical Benefits Program
P.O. Box 8021
Harrisburg, PA 17105
» Special Pharmaceutical Benefits Program - HIV/AIDS



Special Pharmaceutical Benefits Program - Mental Health


Eligibility Requirements:
  • Income Limits: Individuals - $57,450.00 gross income per year Families - $57,450.00 gross income per year, plus an allowance of $20,100.00 for each additional family member. (Example: family of two $77,550.00 combined gross; family of three $97,650.00 combined gross; etc.)
  • Residence: Must be a Pennsylvania resident living in Pennsylvania and not institutionalized.
  • Medical Need: Must have a medical need with a DSM diagnosis of schizophrenia.
  • Resources: Resources such as real property etc. are exempt.
Important Notes: ALL INFORMATION SUPPLIED TO THE SPBP COORDINATOR IS STRICTLY CONFIDENTIAL

If you need help completing this application, please call 1-800-922-9384, or send an email to SPBP@pa.gov.
Contact Information: Phone
(800) 922-9384

Address
Department of Public Welfare
Special Pharmaceutical Benefits Program - SPBPMH
P.O. BOX 8808
Harrisburg, PA 17105
» Special Pharmaceutical Benefits Program - Mental Health


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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.