State Pharmaceutical Assistance Program: Idaho

Every day, there are Medicare beneficiaries searching for ways to help pay for their medications and their Medicare part D prescription drug plan. These beneficiaries struggle to find assistance because they have had an unforeseen expense or they just don’t have the income to pay for the benefits and medications they need. Those that start looking for help often think their only limited to programs that offer assistance on a national level. They don’t realize there are some states that offer help to only their residents.

The states that decide to offer help to their residents have state pharmaceutical assistance programs in place. These state pharmaceutical assistance programs, SPAPs, are only open to those that live within the state that offers them. These programs vary from state to state. Each state that has a SPAP has a different set of eligibility criteria that residents have to meet in order to qualify for the program.

SPAPs are put in place to help the residents in each state. These programs provide benefits because those that are sick and don’t have a lot of resources will shoulder a huge burden alone. These programs are more aware of the struggles of the residents in their state better than the federal programs are.

Idaho is a state that offers their residents help through a state pharmaceutical assistance program.

Idaho AIDS Drug Assistance Program (IDAGAP)

Idaho AIDS Drug Assistance Program is the SPAP program for Idaho. Those that don’t live in the state shouldn’t call to get assistance as it is not open for nonresidents. Those that would like more information should call 208-334-5943 or 800-926-2588.

Eligibility Requirements:

This program is open to those that meet the following requirements:

  • Must be a resident of Idaho
  • Must be HIV positive
  • Must have Medicare part A, B and D coverage (just having only Medicare part A is sufficient as well)
  • Doesn’t qualify for Medicaid OR Low Income Subsidy
  • Must be a participant in an Idaho HIV Medical Case Management Program

Those that want to apply:

Department of Health and Welfare

Po Box 83720

Boise, Id. 83720

What are the Benefits?

Those that qualify for this SPAP will need to be enrolled into a Medicare part D prescription drug plan to enjoy the benefits. This play will not pay for any part D premiums but it will help with the copays Medicare part D beneficiaries will have.

When a beneficiary has a copay for their medications during the initial coverage period and during the coverage gap, IDAGAP will pay for it. This program will pay the copays for the medications on the Medicare part D formulary until the beneficiary reaches catastrophic coverage in their Medicare part D prescription drug plan. Once catastrophic coverage has been reached, IDAGAP benefits will stop until a new benefit year begins.

This is a SPAP that will not pay for medications that are not on the Medicare part D prescription drug plan formulary. Any medications that are not on the approved formulary will not be paid for by the program. Those that need medications that are excluded from the normal formulary will have to follow the appeals process of their prescription drug plan provider to request the medication be covered.

Those that don’t qualify for this state pharmaceutical assistance program should continue to look for help if it’s necessary. There is a state health information program available that can help residents find assistance locally. People that don’t meet the requirements for this SPAP should also contact the Social Security Administration to apply for a Low Income Subsidy.

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