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State Pharmaceutical Assistance Programs — also referred to as SPAPs — are statewide programs that help people pay for the prescription drugs they need.
Every State Pharmaceutical Assistance Program operates differently, however, they broadly intend to help low-income people, seniors, and people with disabilities afford their prescription drugs. Some programs help people with specific ailments — such as HIV/AIDS — while others are geared toward seniors or people with disabilities.
Through this article, we’ll discuss more on what a State Pharmaceutical Assistance Program is, its services, how to find one in your state, and provide a full, state-by-state list of SPAPs around the U.S.
State Pharmaceutical Assistance Program Explained
Seniors in the U.S. spend on average more than $600 a year on prescription drugs. To help seniors, as well as people with disabilities or low-incomes, afford this burden, many states have created a State Pharmaceutical Assistance Program.
As we mentioned above, a State Pharmaceutical Assistance Program (SPAP) assists low-income people, seniors, and people with disabilities afford their prescription drugs.
Some states may coordinate their programs with Medicare’s prescription drug benefits, also referred to as Medicare Part D. In such cases, your SPAP may also help you pay for your insurance premiums, deductibles, and or copayments. Medicare Part D, or Medicare Rx, is Medicare’s prescription drug program, and it helps cover some of the cost of prescription drugs and is offered through different private companies.
Another nuance of SPAPs is their qualifications. Some programs only help a specific group of people, such as people older than 65, people with HIV/AIDS, or those with disabilities. Other SPAPs may entail that you enroll during a particular time frame, which are called Special Enrollment Periods.
Things to Consider with SPAPs
If you’re looking to enroll in a State Pharmaceutical Assistance Program, there are some questions you should be ready to ask and information you’ll likely need.
First, identify if your state has a SPAP. If so, learn who is eligible for the program and what are its requirements. Does it have an age limit, or a Special Enrollment Period? Can I still get help if I’m not older than 65, or not on Medicare or Medicaid? What if my income is above the threshold?
Next, ask what the SPAP can offer you. How will it help with my prescriptions? Will it help pay my insurance premium? Is there an SPAP out-of-pocket maximum? Does the program provide benefits outside of prescription drug costs? How can the program help my family?
Lastly, ask what kind of information they will need for you to complete your application. They may need such information as your address, social security number, income statements, medical records or more.
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States with a State Pharmaceutical Assistance Program
Below is a list of states with State Pharmaceutical Assistance Programs and a bit of information on their programs. Again, keep in mind that every program operates differently.
Contact your state’s program to get more specific information on what services it may provide you. These programs are in part based on information from Medicare Interactive, an online reference tool designed to help older adults and people with disabilities navigate health insurance.
Alabama’s State Pharmaceutical Assistance Program is called the Alabama SenioRx Prescription Assistance. SenioRx helps people with disabilities and folks who are age 55 and older who are diagnosed with chronic medical conditions requiring daily medication. Get more information on the program here, or call them at 1-800-243-5463.
Colorado’s State Pharmaceutical Assistance Program is the Ryan White State Drug Assistance Program. The program helps people pay for expensive HIV medications. The program is open to Colorado residents living with HIV and has an income less than 500 percent of the Federal Poverty Level. Get more information on the program here or call it at 303-692-2783.
Connecticut’s State Pharmaceutical Assistance Program is the Connecticut AIDS Drug Assistance Program or CADAP. The program pays for antiretroviral drugs to prolong the life of people with AIDS or HIV infection. CADAP also pays health insurance premiums for people who have insurance and who are eligible for CADAP. To apply, visit the Connecticut Department of Health’s CADAP website or read more on the Connecticut AIDS Drug Assistance Program.
Delaware’s State Pharmaceutical Assistance Program is the Chronic Renal Disease Program. The program provides assistance to Delaware residents diagnosed with End-Stage Renal Disease. In addition to income thresholds, the program requires that all third-party resources (Medicare, Medicaid, VA, private insurance, etc.) must be considered before CRDP funds are used. Call 1-800-464-4357 to learn more or get more information from the state’s website.
Idaho’s State Pharmaceutical Assistance Program is the Idaho AIDS Drug Assistance Program, which helps people living with HIV or AIDS pay for prescriptions. Learn more about the program and its requirements here.
Montana has two State Pharmaceutical Assistance Programs: The Big Sky Rx Program and the Montana AIDS Drug Assistance Program. The Big Sky Rx program helps Montana Medicare clients pay for Medicare-approved prescription drug insurance premiums. It’s eligible to Montana residents, enrolled in Medicare, and earns income less than $25,760 for a single person or $34,840 for a two-person household. Montana AIDS Drug Assistance Program provides HIV-related services for those who do not have enough health care coverage or financial resources for treating the HIV disease.
North Carolina’s State Pharmaceutical Assistance Program is the HIV Medication Assistance Program. The program provides financial assistance to low-income state residents for the purchase of medications specifically used to combat HIV and infections that are specific to AIDS. Learn more about the program here.
New Jersey has two SPAPs: the Senior Gold Prescription Discount Program and the Pharmaceutical Assistance to the Aged & Disabled (PAAD) program. Senior Gold helps seniors pay for prescription drugs that are older than 65. The PAAD program helps eligible seniors and individuals with disabilities save money on their prescription drug costs. Learn more about PAAD here or learn about Senior Gold here.
New York’s Elderly Pharmaceutical Insurance Coverage (EPIC) Program helps more than 330,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs. Seniors can apply for EPIC at any time and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan. Learn more about the program here or call 800-332-3742.
Oregon offers the CAREAssist program to help people with HIV/AIDS afford prescriptions and treatment. Learn more about the program here or call 971-673-0144.
Pennsylvania offers thee state pharmaceutical assistance programs, including the PACE Prescription Assistance Program for people older than 65, the Special Pharmaceutical Benefits Program for people with HIV/AIDS, and the Chronic Renal Disease Program for people with ESRD. Learn more about PACE at this website or call 800-225-7223. Learn more about the Special Pharmaceutical Benefits Program here or call 800-922-9384. Learn more about the Chronic Renal Disease Program here or call 800-225-7223.
Rhode Island offers the Rhode Island Pharmaceutical Assistance to the Elderly program. The program is available to people older than 65 and people between the ages of 55 and 65 who receive Social Security Disability Insurance (SSDI). Learn more about the program here or call 401-462-3000
Texas offers two prescription drug benefit programs: the Kidney Health Care (KHC) program and the Texas HIV Medication program. The Kidney Health Care program helps people with End-State Renal Disease. The Texas HIV Medication program helps people afford medications for HIV/AIDS. Learn more about KHC here or call 512-776-7150. Learn more about the HIV medication program here or call 888-311-7632
Virginia offers the AIDS Drug Assistance Program (ADAP) for people with HIV/AIDS. Learn more about the program here or call 855-362-0658.
Vermont provides the Healthy Vermonters and VPharm program to Medicare beneficiaries with Part D plans. Learn more about the program here or call 800-250-8427.
Wisconsin offers two prescription drug programs: the SeniorCare program and the Wisconsin Chronic Disease program. SeniorCare offers help to people65 and older, while the Wisconsin Chronic Disease program helps people with chronic renal disease, hemophilia, or adult cystic fibrosis. Learn more about SeniorCare here or call 800-657-2038. Learn more about the Wisconsin Chronic Disease program here or call 800-947-9627
U.S. Virgin Islands
U.S. Virgin Islands’ State Pharmaceutical Assistance Program is the Senior Citizens’ Affairs Pharmaceutical Assistance Program. Learn more about the program here or call 340-774-0930.
While not every state offers a dedicated State Pharmaceutical Assistance Program, many can offer help through to Medicare beneficiaries with Part D plans.
Check to see if you’re eligible for Medicare and for Medicare Part D. If so, you might also be able to reap some benefits from a state pharmaceutical program. Ask your area’s Medicare professional for more information on if your state offers a pharmaceutical benefits program as they will have the most up-to-date information.
We hope through this article you’ve learned what a State Pharmaceutical Assistance Program is, its services, and how to find one around the U.S.