Dear Marci,
I just learned about State Pharmaceutical Assistance Programs, or SPAPs. Can you tell me more about these programs and how they work?
-Jae (Durham, NC)
Dear Jae,
Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help residents pay for prescription drugs. Each program works differently.
States may coordinate their drug assistance programs with Medicare’s prescription drug benefit, Part D. This means that some SPAPs require that you sign up for Part D in order to qualify for assistance.
Your SPAP may help pay for your Part D plan’s:
Premium
Deductible
Copayments
Costs during the coverage gap, if one applies
If a drug is covered by both your SPAP and your Part D plan, both the amount you pay for your prescriptions plus the amount the SPAP pays will count toward the out-of-pocket maximum you have to pay before reaching catastrophic coverage.
Some states have qualified SPAPs. Enrollment in a Qualified SPAP gives you a Special Enrollment Period (SEP) that allows you to enroll in or make changes to your Part D or Medicare Advantage coverage outside of the the usual enrollment periods.
Check this list of State Pharmaceutical Assistance Programs to find out if your state has an SPAP, whether you are eligible, how the SPAP works, and how to enroll. You can also call your State Health Insurance Assistance Program (SHIP) to learn more about SPAPs in your state.
-Marci