As of 2017, there were officially 21 states that have State Pharmacy Assistance Programs (SPAPs) available to residents given each program operates differently from one another, this number is continuing to grow each year. This program allows any Medicare beneficiaries who are on Medicare as well as fixed incomes a chance to rely on SPAP to help pay the expense of any monthly chronic medications. Many states who offer SPAPs work in conjunction with Medicare Part D so that seniors on Medicare can afford to pay for their essential medications, some assist with enrollees who may not qualify for Extra Help.

Do SPAP Payments for Prescription Drug Assistance Count Towards Your Annual Maximum Out of Pocket Costs?

If you have prescription drug coverage from both a SPAP and Medicare Part D, and your drug is covered by both plans, the money that you pay for the price of your prescription and the amount paid by your SPAP will both be counted towards your annual maximum out of pocket costs. You must pay that before reaching the annual limit of $4430 when you then have no more drug costs to pay at all.

Who is Eligible for SPAP Benefits?

Eligibility for State Pharmaceutical Assistance Programs (SPAP) benefits differs from state to state. It is best to first check with your state’s SPAP administrative office to see if you qualify for prescription drug benefits.

In many states those of eligibility include:

  • Patients with either HIV/AIDS.
  • Patients with end stage renal disease.

In some states those of eligibility include:

  • Anyone who is over the age of 65 years old.
  • Anyone who is currently enrolled in Medicare.

Do SPAPs Help Pay for Medicare Part D Deductibles, Premiums, Copayments and Coinsurance?

SPAPs often help you to pay for Medicare Part D copayments, coinsurance, and premiums. In addition, certain SPAPs also give their enrollees a special enrollment period in which you are allowed to either enroll in or make changes to enrollment either in Medicare part D or in a Medicare Advantage Program.

Where Can You Learn More About If Your State has a SPAP Program?

If you are interested in learning more about how to qualify for a SPAP program, contact your State Pharmaceutical Program’ s website if it is available.