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Wisconsin State Pharmacy Assistance Programs (SPAP)

Wisconsin SeniorCare, Wisconsin Chronic Renal Disease, Wisconsin Cystic Fibrosis Program, and Wisconsin Hemophilia Home Care




Wisconsin SeniorCare


Eligibility Requirements: You must meet the following requirements:
  • You must be a Wisconsin resident.
  • You must be a U.S. citizen or qualifying immigrant.
  • You must be 65 years of age or older.
  • You must pay a $30 annual enrollment fee per person.
  • Only income is measured. Assets, such as bank accounts, insurance policies, home property, etc., are not counted.
  • If you are receiving prescription drug coverage from Medicaid you are not eligible.
Important Note: New Prescription Policy for SeniorCare Members:

As of July 15, 2013, the Department of Health Services has implemented a new policy due to the Affordable Care Act for SeniorCare members who get prescriptions. In order for SeniorCare to reimburse pharmacies for prescriptions, the prescription must be written by a physician enrolled with Wisconsin Medicaid. If your physician is not enrolled with Medicaid and you are unable to get your prescription filled, you can take the following action:
  • Encourage your physician to enroll in Wisconsin Medicaid as a Prescribing/Referring/Ordering Only Provider. Your physician can call Provider Services at (800) 947-9627 for more information.
  • Ask your provider to refer you to another physician who is Medicaid-enrolled. You may also call Member Services to find a provider who is Medicaid-enrolled at (800) 362-3002.
Level 1 - At or below $19,008 per individual or $25,632 per couple annually.
  • No deductible or spenddown.

  • $5 co-pay for each covered generic prescription drug.
  • $15 co-pay for each covered brand name prescription drug.
Level 2a - $19,009 to $23,760 per individual and $25,633 to $32,040 per couple annually.
  • $500 deductible per person.
  • Pay the SeniorCare rate for drugs until the $500 deductible is met.
  • After $500 deductible is met, pay a $5 co-pay for each covered generic prescription drug and a $15 co-pay for each covered brand name prescription drug.
Level 2b - $23,761 to $28,512 per individual and $32,041 to $38,448 per couple annually.
  • $850 deductible per person.
  • Pay the SeniorCare rate for most covered drugs until the $850 deductible is met.
  • After $850 deductible is met, pay a $5 co-pay for each covered generic prescription drug and a $15 co-pay for each covered brand name prescription drug.
Level 3 - $28,513 or higher per individual and $38,449 or higher per couple annually.
  • Pay retail price for covered drugs during spenddown.
  • Covered drug costs for spenddown will be tracked automatically. During the spenddown, there is no discount on drug costs.
  • After spenddown is met, meet an $850 deductible per person.
  • Pay SeniorCare rate for most covered drugs until the $850 deductible is met.
  • After the $850 deductible is met, pay a $5 co-pay for each covered generic prescription drug and a $15 co-pay for each covered brand name prescription drug.
Contact Information Phone
(800) 657-2038

Address
Wisconsin SeniorCare
P.O. Box 6710
Madison, WI 53716
» Wisconsin SeniorCare





Wisconsin Chronic Renal Disease


Eligibility Requirements: To be eligible for the CRD Program, a participant must be:
  • A Wisconsin resident.
  • Diagnosed as having End-Stage Renal Disease;
  • Enrolled in Medicare Part A;
  • Paying Medicare Part B and Medicare Part D premiums, if he/she is eligible; and
  • Enrolled in Medicaid, BadgerCare or SeniorCare, if he/she is eligible.
Important Notes: Chronic Renal Disease participants are eligible to receive the following WCDP covered services:
  • Inpatient and outpatient dialysis and transplant treatments.
  • One pre-transplant dental examination, and X-rays.
  • Kidney donor transplant-related medical services.
  • Certain prescription medications and certain home supplies.
  • Certain laboratory and X-ray services.
If a CRD participant is a Medicare participant at the time of application, the eligibility date is determined by the date of the initial treatment. However, if the participant is Medicare-eligible but has chosen not to pay for premiums, the WCDP eligibility date is designated as the date that Medicare benefits are initiated.
Contact Information: Phone
(800) 947-9627
(800) 362-3002

Address
Chronic Disease Program ATTN: Eligibility Unit
P. O. Box 6410 Madison, WI 53716
» Wisconsin Chronic Renal Disease



Wisconsin Cystic Fibrosis Program


Eligibility Requirements: To be eligible for the CFP Program, a participant must be:
  • A Wisconsin resident.
  • Diagnosed by the medical director of a cystic fibrosis treatment center as having cystic fibrosis;
  • 18 years of age or older; and
  • Enrolled in Medicaid, BadgerCare or SeniorCare, if he/she is eligible.
  • Adult cystic fibrosis participants are not eligible for retroactive eligibility; therefore, they become eligible for Wisconsin Chronic Disease Program (WCDP) benefits on the date the application was received by the WCDP.
Important Notes: Adult Cystic Fibrosis participants are eligible to receive the following WCDP covered services:
  • Inpatient and outpatient services directly related to the disease.
  • Certain physician services.
    • li>Certain laboratory and X-ray services.
  • Certain prescription medications.
  • Certain home supplies.
Contact Information: Phone
(800) 947-9627
(800) 362-3002

Address
Wisconsin Chronic Disease Program
P. O. Box 6410 Madison, WI 53716
» Wisconsin Cystic Fibrosis Program


Wisconsin Hemophilia Home Care


Eligibility Requirements: To be eligible for the HHC Program, a participant must be:
  • A Wisconsin resident.
  • Be diagnosed by a comprehensive hemophilia treatment center as having hemophilia;
  • Enrolled in Medicaid, BadgerCare or SeniorCare, if he/she is eligible;
  • Have a written agreement with a comprehensive hemophilia treatment center for compliance with a maintenance program. The agreement must specify:
    • The services to be provided;
    • The responsibilities of the participant and the center relating to the development of the plan of treatment and conformance of the participant to applicable center policies;
    • The manner in which services are to be controlled, coordinated and evaluated by the center; and
    • Procedures for semi-annual evaluation of the maintenance program and for verification that the participant is complying with the established treatment regimen.
Important Notes: Hemophilia Home Care participants are only eligible to receive services for blood derivatives and supplies necessary for home infusion. A $10 participant copay will be applied to each prescription and blood product covered by the program.
Contact Information: Phone
(800) 947-9627
(800) 362-3002

Address
Wisconsin Chronic Disease Program
P. O. Box 6410
Madison, WI 53716
» Wisconsin Hemophilia Home Care




Medicare Supplements
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  • 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.
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  • 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.
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  • 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.
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