If you need assistance with your Medicare Part D costs, an SPAP may be an option for you. What are State Pharmaceutical Assistance Programs, and are you eligible for one?
For many people, prescription drugs act as a critical aspect of their overall health care that can help relieve symptoms of a condition or maintain a certain level of health. This is especially true for seniors or those living with a chronic health condition, which accounts for nearly half of the United States population. If you fall into one of these categories, there’s a chance you’re eligible for Medicare Part D, which offers coverage for many prescriptions you may need. Sometimes, even with coverage, the costs of prescription drugs may create a large burden on your finances, but you can’t stop taking critical prescriptions. So, what options do you have? Well, one solution to this question may be SPAPs.
What are SPAPs?
State Pharmaceutical Assistance Programs (SPAPs) are basically what they sound like — programs that are run by the state to assist with prescription drugs costs. Since they’re run by the states, each state may have different programs that cover different needs. In some cases, a state may choose to not have an SPAP for citizens. As of 2021, nearly every state has a SPAP in some form, with some states offering several specialized programs. For example, Pennsylvania has four programs — Pharmaceutical Assistance Contract for the Elderly (PACE, but different from Medicare/Medicaid’s PACE), PACE Needs Enhancement Tier (PACENET), the Special Pharmaceutical Benefits Program — HIV/AIDS, and the Special Pharmaceutical Benefits Program — Mental Health.
SPAPs can be specialized for a number of different needs.
These programs are often utilized alongside Medicare, but, as you can see from the programs in Pennsylvania, they aren’t all geared towards seniors. SPAPs can be specialized for a number of different needs. While this means that there’s a good chance your state has an SPAP, it may not be one for seniors. Currently, less than half of all states have an SPAP for seniors. So, how can you tell if your state has a program that you’ll qualify for? You could talk to a licensed insurance agent or your State Health Insurance Assistance Program (SHIP). Both should be aware of assistance programs in your state. You could also go through the SPAP program search we linked to earlier, which has every SPAP broken down by state and eligibility categories.
What Can They Help With?
As you could probably guess, since each state has its own SPAPs, each program covers things a little differently. For example, if your state’s SPAP is specific to a certain condition, it may only cover drugs for that. For example, Georgia’s AIDS Drug Assistance Program (ADAP) covers prescription costs for medications that treat HIV or infections related to HIV. Other states, like California, may still only cover those with HIV or AIDS for the SPAP, but may cover Part D premiums and other out-of-pocket costs as well.
This illustrates how two similar states with similar programs can vary, making it all the more important that you look into the specifics of what your state offers.
Other programs are more specifically focused on seniors in need of financial assistance. An example of this is the PACE and PACENET programs in Pennsylvania, which can set copays and pay a portion of premiums. Similarly, New York’s Elderly Pharmaceutical Insurance Coverage (EPIC) program can work with Medicare Part D to make prescriptions costs more affordable for seniors. Unlike PACE, EPIC doesn’t pay for the regional average premium for Part D plans, instead focusing directly on drug costs. This illustrates how two similar states with similar programs can vary, making it all the more important that you look into the specifics of what your state offers.
How Can You Get Help?
Now on to the big question — if you need additional help with your Part D costs, how can you find it? There are plenty of places you can start. As mentioned earlier, speaking with a licensed insurance agent may help you to find a plan that aligns with your financial needs. Your SHIP may also be a great resource if you have any questions about financial aid. Additionally, the links that we provide in this article, especially the Medicare.gov SPAP list, can also be a great place to begin your search for an SPAP that you meet the criteria for. Of course, you’ll need to do your research into the SPAP, since not all programs are available to all seniors.
This process will be different for each SPAP, but you’ll generally fill out an enrollment form to begin the process.
Once you find an SPAP that you qualify for, you’ll need to enroll in the program. This process will be different for each SPAP, but you’ll generally fill out an enrollment form to begin the process. For example, here is Pennsylvania’s PACE enrollment form, which requires submission of financial and personal data and a health survey. If you are enrolled in PACE (or PACENET), you’ll receive a confirmation letter in the mail, among other program and Part D plan information. For specifics on other SPAPs, we suggest you see what’s available in your state.
State Pharmaceutical Assistance Programs can really help seniors make their prescription drugs more affordable. If you’re in a state that has an SPAP and you qualify, that’s great! If not, there are other programs, like Extra Help, which may bring some of the costs in line with what’s affordable to you. You may even be able to look into non-governmental options like GoodRX. Medicare is meant to make health care affordable for beneficiaries, but that additional assistance is sometimes a necessity. It’s good to know that not only is there a way to get help if you need it, there are also multiple avenues you can explore!
Just like you, your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. Your doctor will know your own health best.