Get Latest WorkWORLD

State Pharmacy Assistance Program (SPAP)

State Pharmacy Assistance Programs (SPAPs) are state sponsored programs that provide senior citizens and individuals with disabilities increased access to prescription drugs by paying for or reducing drug coverage. Under the new Medicare Part D drug benefit, an SPAP is defined as a state program that provides financial assistance for supplemental prescription drug coverage for Part D eligible individuals. The states have two options:

·          Supplement Medicare beneficiaries' drug coverage by providing its own state supplemental benefit program or purchasing additional benefits through private insurance plans; or

·          State SPAPs can contribute to cost sharing that will count towards the beneficiary's true out of pocket expenditures (TrOOP).

True Out of Pocket (TrOOP) Expenditures

Only those costs actually paid by the beneficiary and not reimbursed by a third-party (such as a supplemental insurance plan sponsored by a former employer) will count toward the limit that determines the start of the catastrophic coverage. Most third-party assistance, such as that from employers and unions, does not count toward the TrOOP limit. By law, assistance provided by family members and Medicare's new low-income cost sharing subsidy (which pays all but nominal co-pays in most cases) counts toward TrOOP. Also, help from state pharmaceutical assistance programs counts. Additionally, CMS determined that assistance from charities unaffiliated with employers or unions including patient assistance program does count toward TrOOP.

Qualified State Pharmaceutical Assistance Programs Under the MMA*

*Note: This list is based on qualified SPAP attestation forms received by CMS as of May 17, 2006.

Additional Information

For more information about State Pharmacy Assistance Programs and Medicare prescription drug coverage interactions, see:
Quick Facts about Medicare's New Coverage for Prescription Drugs for people who get help from their state pharmacy program to pay for their prescriptions, available online at:
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=11108

State Pharmacy Assistance Programs are in a state of flux due to the changes brought about by the Medicare Modernization Act and the introduction of Medicare Part D Prescription Drug Coverage. With their targeted population eligible for additional prescription drug coverage, many SPAPs soon will be making major changes in program structure and design. Several policy briefs have examined results from a recent Georgetown University study of SPAPs, their implementation, and operational experience. They are published on the Changes in Health Care Financing and Organization's website:

·          State Pharmacy Assistance Programs at a Crossroads: How Will They Respond to the Medicare Drug Benefit?, available online at:
http://www.hcfo.net/pdf/brief0705.pdf

·          State Pharmacy Assistance Programs vs. Medicare Prescription Drug Plans: How Do They Contain Rising Costs?, available online at:
http://www.hcfo.net/pdf/issue1005.pdf

Source

http://www.cms.hhs.gov/States/Downloads/StateExecutiveBranchChecklist.pdf

http://www.cms.hhs.gov/States/Downloads/Package1.pdf

http://www.cms.hhs.gov/States/Downloads/QualifiedSPAPList.pdf

http://www.medicare.gov/Publications/Pubs/pdf/11108.pdf

WorkWORLD™ Help/Information System

   Share/Save: Click the button or link at left to select your favorite bookmark service and add this page.

This is one topic from the thousands available in the WorkWORLD™ software Help/Information System.
Complete information about the software is available at: http://www.WorkWORLD.org