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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 - $58,850.00 gross income per year Families - $58,850.00 gross income per year, plus an allowance of $20,800.00 for each additional family member. (Example: family of two $79,650.00 combined gross; family of three $100,450.00 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
  • Individuals - $58,850.00 gross income per year Families - $58,850.00 gross income per year, plus an allowance of $20,800.00 for each additional family member. (Example: family of two $79,650.00 combined gross; family of three $100,450.00 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:
  • Individuals - $58,850.00 gross income per year Families - $58,850.00 gross income per year, plus an allowance of $20,800.00 for each additional family member. (Example: family of two $79,650.00 combined gross; family of three $100,450.00 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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