The Medicare Modernization Act intends that all Part D plans in a State be given comparable opportunities, promoting competition among Part D plans that want to provide benefits in a particular State. This provides a variety of good choices for all Part D eligible individuals and those beneficiaries enrolled in State Pharmacy Assistance Programs will have the same freedom of choice.However, not all states have a State Pharmacy Assistance Program - and each state with a SPAP can have different rules governing their program. So. in general, each state that has a State Pharmacy Assistance Program will decide how the state's program works with the Medicare drug coverage.
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Some states may choose to give extra coverage when you join a Medicare drug plan to assist with your out-of-pocket expenses (monthly plan premiums or cost-sharing).
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Other states may have a separate state program that helps with prescriptions.
For more information, please contact your SPAP.
Question: What exactly is a SPAP?
state-funded programs that provide low-income and medically needy senior citizens and individuals with disabilities financial assistance for prescription drugs. The [Medicare Modernization Act] allows State Pharmacy Assistance Programs to “wrap around” the Medicare benefit to fill gaps in [Part D drug] coverage.Question: Are the benefits I receive from the SPAP to pay for my drug coverage count toward meeting my annual total out-of-pocket spending (TROOP) threshold?
Yes. The payments that a SPAP makes toward your Medicare Part D formulary drugs counts toward meeting your annual TrOOP threshold. Once you exceed your annual TrOOP threshold, you will not have any additional costs for formulary Part D drugs through the remainder of the year.
Sources include:
U.S. Department of Health & Human Services
State Pharmacy Assistance Programs Medicare Modernization Act —Final Rule, Fact Sheet