Pa Pace Formulary 2021

UPDATED NOVEMBER 24, 2021. There are two State Pharmaceutical Assistance Programs (SPAPs) in Pennsylvania: Pennsylvania PACE and Pennsylvania PACENET. They offer low-cost prescription drugs to qualified Pennsylvania residents 65 years of age and older. When you enroll in PACENET and Medicare prescription drug coverage, PACENET pays for prescription drugs that are not included in the Medicare drug plan formula and prescription drugs that are filled during coverage gaps as long as the PACENET program currently covers the drug. If you are enrolled in Medicare prescription drug coverage, you do not have to pay the PACENET monthly premium at the pharmacy, depending on your situation. Contact PACENET for more information. If you are covered by a Medicare Advantage (HMO) plan or an employer-sponsored retirement benefit that pays for your doctor`s and hospital visits, and you want to enroll in Medicare prescription drug coverage, you will need to contact your insurance company directly. When you enroll in a Medicare drug plan through your Medicare Advantage plan, the PACE program pays your Medicare premium if your Medicare Advantage plan has signed an agreement with the program. The formula is the list of drugs covered by community care. It is also called the “list of medications.” The drugs on this list were selected with the help of doctors and pharmacists. The list must meet the requirements of Medicare and/or Medicaid. The formula explains which prescription drugs are covered by the plan.

It also tells you if there are any rules that limit the coverage of a drug. PACE offers prescription and certain over-the-counter medications for all members.b). If your Part D plan contains a restrictive drug formula, PACE will cover your prescription drugs or work directly with the Part D plan to process a pre-approval on your behalf Hardware ID: H5212_Form_11.2015 CMS Approved: 08.12.2015 PACENET income limits are slightly higher than PACE`s. . The annual income must be less than $14,500 for individuals and less than $17,700 for married couples. The income qualification is based on the previous year`s salary and includes both taxable and non-taxable sources. Assets such as the value of the home, vehicle and savings are not considered factors that determine eligibility. Premiums for Part B of health insurance are also excluded. For those who are in PACENET, the amount your insurance company pays for your prescriptions doesn`t count towards your deductible, but any co-payment you make under your other plan counts. You can also get a request on the Ministry of Aging website. Click this link www.aging.state.pa.us. Then, go to the left side and click on “Prescription Help”.

For more information about PACE programs available in Pennsylvania, visit PACE, PACENET and PACE Plus Medicare or call 1-800-225-7223. If you would like to apply, click here. Eligibility for PACE and PACENET is determined by your previous calendar year`s income. As of 2014, Medicare Part B Social Security premiums are excluded from income. This change has the same effect as increasing the income limits by this amount. For most Medicare recipients, this amount is $1,626.00 per person for one year. For married couples, the excluded amount would be $3,252.00 for one year. To get help from PACENET, you must be 65 years of age or older, have a limited income, and not be enrolled in Medicaid.

. Covered medications: Only drugs that require a doctor`s prescription to be dispensed are covered. Insulin, insulin injections and insulin needles are the only exceptions. Over-the-counter medications such as aspirin, antacids, vitamins, etc. and investigational drugs are not covered, even if prescribed. Once PACENET members reach the deductible amount of $40 per month (cumulatively at $480 per year), they are responsible for a co-payment of $8 for generic prescription drugs and a co-payment of $15 for brand-name prescription drugs. Generic brand-name drugs versus trade names: A generic brand-name drug contains the same active ingredients as its equivalent brand name drug and is just as effective. However, the generic drug is usually much cheaper. PACE urges you to discuss the use of low-cost (generic) multi-source drugs with your doctor and pharmacist. Eligibility: You are eligible for PACE if you have been a resident of Pennsylvania for at least 90 consecutive days before applying.

You are 65 years of age or older; and you had a total income for the previous calendar year of less than $14,500 for a single person or less than $17,700 for a married couple living together. Not eligible to receive PACE/PACENET? Maybe the clearing-house mechanism can help. Consult the clearing-house mechanism brochure, contact the clearing-house mechanism or call 1-800-955-0989. Drugs that are on the Federal Food and Drug Administration`s (FDA) DESI list are not covered unless your doctor writes “medically necessary” on your prescription. DESI drugs are those for which the manufacturer has not provided the FDA with satisfactory evidence of efficacy and safety. Unlike many government pharmaceutical assistance programs, enrollment in a Medicare Part D plan is not a requirement for PACE or PACENET members. However, PACENET members are encouraged to sign up for a Part D plan. Those who do not register will be charged $37.03 in monthly premiums. All programs offer assistance in the form of very small co-payments for prescription drugs. Pharmacies offer free drug delivery for all seniors If you don`t currently have Medicaid or PACE coverage, PA PAP will help you seek prescription help through various programs. Click here for the brochure. For more information, call 1-800-955-0989.

. Registration for the PACE program is free. PACENET participants have a registration fee of $37.03/month. However, if they enroll in a Medicare Part D plan, these fees will be waived. The State of Pennsylvania offers three prescription assistance programs to its residents; the Pharmaceutical Assistance For the Elderly, or PACE for short, the PACE Needs Enhancement Tier or the PACENET Companion Program, and the third option is a Medicare Part D companion program called PACE Plus Medicare. Placement in one of these programs is determined by the previous year`s annual income and whether or not the applicant has Medicare Part D. Therefore, eligibility for the 2019 calendar year takes into account the applicant`s 2018 income for eligibility. PACE pays the total costs of a senior`s drugs, with the exception of the monthly co-payments of $6 for generics and $9 for brand-name drugs. PACENET has similar benefits, but has co-payments of $8 for generics and $15 for brand-name drugs. .

PACE and PACENET programs: The Senior Pharmaceutical Assistance Contract (PACE) and the PACE Needs Enhancement Tier (PACENET) help eligible Pennsylvania residents 65 years of age or older pay for their prescription medications. .