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DE Prescription Assistance Program - Overview

The Delaware Prescription Assistance Program (DPAP) is the State Pharmacy Assistance Program (SPAP) and provides up to $2500 per individual in each State fiscal year for eligible clients. (The State fiscal year runs from July 1st through June 30th.)

The goal of the program is to provide prescription assistance to elderly and/or disabled individuals currently without prescription coverage who have incomes below 200% of the Federal Poverty Level (FPL) or have prescription costs exceeding 40% of their income.

NOTE: Income limits discussed above became effective February 1, 2006 for use of the 2006 Federal Poverty Level guidelines.

This program covers medically necessary prescription drugs (and over-the-counter drugs when prescribed by a physician). The program does not pay for any of the drugs or diabetic supplies for Medicare recipients. Medicare currently covers these supplies for both insulin and non-insulin dependent patients.

NOTE: See the Medicare Part D Prescription Drug Coverage - Overview topic for comprehensive information about the new Medicare program that became effective January 1, 2006.

Clients must make a co-payment of $5 or 25% of the cost of the prescription, whichever is greater. The co-pay is collected by the dispensing pharmacy.

Eligibility

Clients must reside in the State of Delaware. They must be at least 65 years old or receiving Social Security Disability benefits [either Social Security Disability Income (SSDI) or Supplemental Security Income (SSI)].

NOTE: An individual who is no longer getting SSDI or SSI is considered to meet the "receiving Social Security Disability benefits" requirement if the individual is a former recipient of SSDI or SSI and was required by the Social Security Administration to switch to Social Security Survivors benefits.

The countable income eligibility limit is set at 200% of the Federal Poverty Level (FPL). Couples are counted as two individuals. Individuals with income over 200% of FPL can qualify if they have prescription costs exceeding 40% of their countable income.

NOTE: FPL is published annually. The income eligibility standard based on the FPL will be issued within 10 business days after the FPL is published. The revised income eligibility standard will be used to determine eligibility for the month following the month in which the standard is issued.

Individuals wishing to apply for DPAP should call the DPAP program information number. (See: DSS Contact Information.) Applications are handled through the mail. Applicants do not need to come into an office to apply. Applicants will need to provide proof of income with their signed and dated DPAP application.

Those age 65 and over who are eligible for the Nemours Foundation prescription benefit are not eligible for DPAP. DPAP does not replicate coverage for Nemours clients.

See also:

DE Medicaid - Overview

DE DSS - Change Reporting Requirements

DE DSS - Contact Information

Source:

http://www.state.de.us/inscom/departments/elder/pillbill.shtml
http://www.dhss.delaware.gov/dhss/dss/dpap.html
DSS Policy Manual (Sect. 30000), and DSS Administrative Notice A-06-2005, February 22, 2005.

Back to:

DE Division of Social Services - Overview

DE Benefit Information System Overview

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