State Pharmaceutical Assistance Program: Massachusetts

Medicare beneficiaries sometimes struggle to pay for their Medicare part D prescription drug plan. They don’t know how they are going to pay for their prescription drug plan because they don’t have enough income or they find that their income isn’t enough to pay for their mounting medication costs. As Medicare beneficiaries realize the financial strain they have, they begin to look for different assistance programs to help. Many of these beneficiaries immediately look to assistance programs with a national mission before they look for a local assistance program.

Those that don’t look for local assistance programs don’t realize they are overlooking valuable assistance. There are states that offer assistance to the residents in their states only. These programs, state pharmaceutical assistance programs, are put in place to help those Medicare beneficiaries pay for their medication needs.

State pharmaceutical assistance programs, SPAPs, are put in place to help those that need the most help. These assistance programs normally have different criteria that has to be met for residents to qualify but the help that is given is needed. States know the struggles that their residents have and those that have the resources available have created assistance programs to help ease the struggles of their residents.

Massachusetts is a state that offers residents a state pharmaceutical assistance program.

Massachusetts Prescription Advantage

Massachusetts Prescription Advantage is the SPAP for Massachusetts. This is a program that is only for the residents of Massachusetts. Those that don’t live in the state shouldn’t apply. Residents of Massachusetts that want more information should call 800-243-4636 ext. 2.

Eligibility Requirements:

Massachusetts residents only

65 years old and over: Those with Medicare can have an income up to the 500% Federal Poverty Limit and those without Medicare shouldn’t work more than 40 hours a month, meet CommonHealth disability guidelines and have an income up to 188% of the Federal Poverty Level

If Medicare eligible, must have a Medicare part D prescription drug plan or credible coverage

Who to Contact:

Those that want to apply should contact:

Massachusetts Prescription Advantage

Po Box 15153

Worcester, Ma. 01615

What are the Benefits?

Those that meet the requirements for this SPAP will see there are many benefits they can enjoy under this program. Eligible beneficiaries will fall into one of two categories.

Beneficiaries that have Medicare will enjoy the following benefits:

  • Copayment assistance for those that are enrolled into a Medicare part D prescription drug plan or credible coverage (the copayment assistance is based upon the annual income for that household)
  • The out of pocket spending limit for those with prescription drug insurance is limited (once the set out of pocket spending limit is reached, Massachusetts Prescription Advantage will pay the co-payments for the remainder of the plan year)
  • Assistance with medications covered by the Medicare prescription drug plan formulary (if benzodiazepines aren’t allowed on that formulary, Massachusetts Prescription Advantage will help pay for those as well)

Beneficiaries without Medicare will enjoy the following benefits:

  • Those that have a deductible will have to satisfy their deductible then they will only have a small copayment because Massachusetts Prescription Advantage will then help pay for the copayments (depending on the annual household income, beneficiaries can apply to have their deductible waived)
  • When the out of pocket spending limit in has been met, Massachusetts Prescription Advantage will pay the copays for beneficiaries for the remainder of the benefit year
  • Those that don’t have Medicare will have to follow the formulary that Massachusetts Prescription Advantage has decided. These medications are categorized as generic, brand and additional brand named medications. To get the specific formulary, eligible beneficiaries can speak with a representative of the SPAP.

Those that don’t qualify for assistance with this SPAP should look for assistance with the Social Security Administration’s Low Income Subsidy Program.

Jan. 1 14'

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