Pennsylvania PACE Programs: Help with Medicare Part D in PA

Pennsylvania PACE - Pennsylvania PACENET

There are two Pharmaceutical Assistance Programs in Pennsylvania: Pennsylvania PACE program and Pennsylvania PACENET program. Both of them help with Medicare Part D. They provide low-cost prescription drugs to qualified Pennsylvania residents age 65 and older. Both may be coupled with Medicare Part D – a program known as PACE Plus program.

Pennsylvania PACE (Pharmaceutical Assistance Contract for the Elderly)

  • Eligibility

– Age 65 and older; and

– A Pennsylvania resident for at least 90 days; and

– Cannot be enrolled in Medicaid; and

– Annual income must be less than $14,500 for individuals and less than $17,700 for married couples. Income qualification is based on prior year’s income and includes taxable and non-taxable sources. Assets and resources are not counted as income.

  • Benefits

– Drug cost will be no more than $6.00 for a generic drug; $9.00 for brand name drug

– With Part D and PACE enrollments, cardholders receive help with:

a). PART D premium (up to the regional benchmark)

b). If your Part D plan has a restrictive drug formulary, PACE will cover your prescription medications, or work directly with the Part D plan to process a prior authorization on your behalf

c). Coverage during the coverage gap

d). Part D cardholder cost sharing is reduced to the PACE copays and premiums

  • Cost

– There are no costs to enroll in the PACE program

Pennsylvania PACENET (PACE Needs Enhancement Tier)

  • Eligibility

– Age 65 years and older; and

– A Pennsylvania resident for at least 90 days; and

– Must not be enrolled in Medicaid; and

– An annual income between $14,500 and $23,500 for individuals, and between $17,700 and $31,500 for married couples. Income qualification is based on prior year’s income and includes taxable and non-taxable sources. Assets and resources are not counted as income

  • Benefits

– Drug cost will be no more than $8.00 for a generic drug; $15.00 for brand name drug

– With Part D and PACENET enrollments, cardholders will receive help with:

a). The PACENET deductable, however, you will have to pay the PART D plan premium

b). If your Part D plan has a restrictive drug formulary, PACENET will cover your prescription medications, or work directly with the Part D plan to process a prior authorization on your behalf.

c). Coverage during the coverage gap

d ). Part D cardholder cost sharing is reduced to the PACENET copays and premiums.

  • Cost

– PACENET participants have an enrollment fee of $39.45 / month. However, if they enroll in a Medicare Part D plan, that fee is waived.

For more details of the available Pennsylvania PACE programs, please visit PACE, PACENET, and PACE Plus Medicare, or call 1-800-225-7223. If you want to apply, click here.

Pennsylvania Patient Assistance Program Clearinghouse (PA PAP)

If you do not currently have Medicaid or PACE coverage, PA PAP will help you to apply for prescription assistance through various programs. Click here for brochure. For more information, call 1-800-955-0989.