| Fri, Jul 15, 2011 @ 09:00 AM

Assistance with Medicare Prescription Drug Coverage

Posted by Medicare Made Clear

A number of drug companies have Pharmaceutical Assistance Programs (PAPs) available to help people enrolled in Medicare Part D pay for prescription drugs.

For people with limited resources, there are several ways to get assistance with Medicare prescription drug coverage. Less than half of the people who qualify actually sign up, so if you think you may meet the criteria for financial assistance, don’t hesitate to apply.

If you meet certain income and resource limits, a Medicare program called Extra Help (also known as Low-Income Subsidy, or LIS) is available. Some states operate State Pharmaceutical Assistance Programs (SPAPs). Many drug companies have Pharmaceutical Assistance Programs (PAPs). All of these can help with prescription drug premium assistance. Each program has individual qualification requirements, so you’ll need to check with Social Security, your state or the drug manufacturer for specific guidelines.

Extra Help from Medicare and Social Security

Extra Help from Medicare and Social Security can assist those with certain resource limitations pay for prescription drugs. The income eligibility levels vary by state and program. For 2011, the average income eligibility level is close to $16,335 a year for an individual and $22,065 for a couple. Qualifying members can pay as low as $2.50 for generic drugs and $6.30 for brand-name drugs. There were some automatic qualification changes in 2011 Medicare coverage so be sure to carefully explore your Extra Help eligibility each year, even if you’ve had it in the past. You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:

  • Have full Medicaid coverage, or
  • Get help from your State Medicaid program paying your Part B premiums (in a Medicare Savings Program), or
  • Receive Supplemental Security Income (SSI) benefits

State Pharmaceutical Assistance Programs (SPAPs)

Many states and one U.S. territory operate State Pharmaceutical Assistance Programs (SPAPs), and these programs offer help paying drug plan premiums and other costs. Some states have more than one program, with individual programs dedicated to a particular disease or medication treatment. For example, Texas has an HIV State Pharmacy Assistance Program.

Each state has different qualification requirements but many requirements are similar. Common criteria include state residency, income maximum, licensed physician’s diagnosis and proof of ongoing treatment. SPAPs are not available in all states, so to get specific information about programs available go to the State Pharmaceutical Assistance Program page and select your state.

Pharmaceutical Assistance Programs (PAPs)

A number of drug companies have Pharmaceutical Assistance Programs (PAPs) available to help people enrolled in Medicare Part D pay for prescription drugs. Qualification criteria are different for almost every drug manufacturer, so for specific information go to the PAP site and select the drug that you have been prescribed. For each drug listed there is a table of information that includes:

  • Drug name
  • Drug company
  • Drug program
  • Eligibility criteria
  • Benefits/assistance
  • Contact information

It will require some research and homework on your part, but if you have limited resources and need assistance with your Medicare Part D prescription drug coverage there are programs available that can help you. The Extra Help program, State Pharmaceutical Assistance Programs and drug manufacturer Pharmaceutical Assistance Programs can reduce costs of prescription drugs to those who qualify.

For more information contact the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact UnitedHealthcare® Medicare Made Clear at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, 7 days a week.

Help for Lower Incomes – MedicareMadeClear.com

Help with Medical and Drug Costs – Medicare.gov

Apply for Extra Help with Medicare Prescription Drug Plan Costs – SSA.gov

Y0066_110624_163244 File & Use 07062011