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State Pharmaceutical Assistance Programs
(includes subsidies and discounts for seniors, disabled, uninsured and others)

Updated June 6, 2008 

Prescription drug assistance has been a substantial and growing state interest for a number of years, generally in response to residents who lack insurance coverage for medicines or who were not eligible for other government programs.  In fact, the first states to authorize and fund direct subsidy programs did so in 1975.  Between 2000 and 2006 at least 26 states authorized and/or started pharmaceutical assistance programs, many intended to aid low-income elderly or persons with disabilities who do not qualify for Medicaid.  As of January 2008, at least 42 states had established or authorized some type of program to provide pharmaceutical coverage or assistance.  The subsidy programs, often termed "SPAPs," utilize state funds to pay for a portion of the costs, usually for a defined population that meets enrollment criteria.  In addition, an increasing number of states use discounts or bulk purchasing approaches that do not spend state funds for the drug purchases, listed as "Discount Programs" below.

The Medicare Pharmaceutical Benefit: The federal law establishing Medicare prescription drug benefits, often termed "Part D,"  became fully operational on January 1, 2006. The Part D program, based on a network of private insurers, has had a sweeping impact on most of the state "SPAP" programs and the people they serve.   Most states that had been paying for nearly 100 percent of drug subsidies chose to shift some or all of their programs to provide a supplemental or "wrap around" benefit, so that Medicare-eligible enrollees would receive "primary" coverage through a Part D Prescription Drug Plan, regulated and funded under federal law.  These states converted their efforts to "secondary, wrap around coverage," most often paying for some or all of the required enrollee share of:

monthly premiums (up to a "standard" of $27.93 month for 2008; averaging about $25.00 nationally)  co-insurance or co-payments (often 25% of purchase price)

annual deductibles (up to $275 in 2008)  the "gap" or "doughnut hole" (starts at $2,510 to $5,726.25 in 2008)

The Part D "base beneficiary premium" for 2008 is $27.93 according to the Centers for Medicare and Medicaid Services.  2008 Enrollment in Medicare Part D prescription plans was open only from November 15, 2007 to December 31, 2007.
^{NOTE:  The actual Part D premiums paid by individual beneficiaries equal the base beneficiary premium adjusted by a number of factors.  In practice, premiums vary significantly from one Part D plan to another and seldom equal the base beneficiary premium.}

The commercial Part D Prescription Drug Plans (PDPs) are allowed considerable variation in their Medicare enrollee charges, so states' roles and contributions also may vary.  NCSL maintains a Summary Table of Wrap Around Plans within a separate report: "State Pharmaceutical Assistance Programs in 2006-07: Helping to Make Medicare Part D Easier and More Affordable"  It features an analysis of laws and regulations providing drug wrap around benefits, coordination and ease of enrollment for 1.5+ million residents in more than 20 states.

State Discount Programs

Beginning in 1999, a gradually growing number of states established prescription drug discount programs, sometimes termed "Rx Buying Clubs" or Discount Cards.  These state-sponsored efforts differ from the "SPAPs" or subsidy plans in at least two ways:  Discount programs do not use state or feral funds to actually pay for pharmaceuticals.  Instead they generally rely on the large-volume purchasing power of the state, to negotiate a sizable discount on a wide selection of prescription products, brand and generics.  A majority of such programs have contracted with a management firm such as a pharmaceutical benefit manager (PBM) to handle the negotiations over price.  The consumer still pays the resulting discounted price at the pharmacy counter, and the state is not involved in the individual transactions.  Unlike most subsidized SPAP programs, there is no comparable federal program or federal regulation affecting these discount plans.  Drugs purchased in this way do not count as part of Medicare or Part D calculations.  In the past three years, a growing number of states have emphasized serving residents under age 65, the population segment not eligible for Medicare or Part D.  In Table 2 below, this report describes 18 operational state discount programs and another 10 that are not currently operational.

Special, Limited Eligibility SPAPs

Under the legal authority of the federal Medicare law, the definition of SPAP allows certain limited-function state programs to be treated as "Qualified SPAPs."  Usually these program only serve individuals with a single diagnosed medical condition, and the often provides benefits beyond just pharmaceuticals.  Examples include: California Genetically Handicapped Persons Program, California Children's Services, Maryland Kidney Disease Program, Texas Kidney Health Care Program, and Virginia DMHMRSAS (Mental Health) Community SPAP.  These single-disease health programs are mentioned or listed as "special" in this report but may not be tallied equally with the major, open-enrollment pharmaceutical assistance programs.

RECENT HISTORY:

2008 Highlights:  Colorado Cares Rx became operational February.  Florida's discount program began in January.  WinconsinCare began a Medicare wrap around benefit in January.

2007 Highlights:  Colorado enacted a discount program for uninsured residents in January. Delaware extended their subsidy "DPAP" program, allowing applicants to obtain prescription drug coverage through the state while the applicant pursues Medicare Part D enrollment.  Florida launched Florida Discount Drug Card effective January 1, 2008. Maine enacted additional Part D state consumer protections for seniors.  Maryland now requires a person to enroll in a specific prescription drug plan or Medicare Advantage Plan in order to get state wrap around benefits. Washington reaffirmed a Part D wrap around program begun in mid-2006 and re-launched an expanded discount plan in mid-March.  The Wisconsin SeniorCare program, by special act of Congress in May 2007, is allowed to continue using its Pharmacy+ waiver for federal matching funds instead of transferring enrollees into Part D plans.   See NCSL's 2007 Prescription Drug Legislation report.

2006 Highlights:  Arizona created a benefit for Medicare dual-eligibles to cover 100% of the patient co-payment. California is providing coverage for drugs not included on the Medicare full-benefit dual eligible beneficiary’s prescription drug plan’s formulary and separately enacted a discount program for residents of any age up to 300% FPL or with Rx expenses at least 10 percent of annual income  Illinois expanded SPAP coverage to residents with HIV/AIDS.  New Jersey and Pennsylvania enacted comprehensive wrap around features for their state subsidy programs. South Carolina redesigned their subsidy program to focus on Medicare gap coverage for expenses over $2,250 annually.  Washington launched a first-time subsidy program covering the prescription drug co-payments for over 100,000 dual-eligible low-income elderly and disabled individuals.  North Carolina re-created a limited subsidy wrap around program, covering premiums up to $216 /year.  Nevada added eligibility for persons with disabilities.  Kansas launched a discount plan for residents not eligible for Medicare or other funded assistance. Tennessee created CoverRX, a prescription drug plan that targets uninsured and poor residents, effective January 2, 2007.

As of December, 2007, 30+ states, including Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Vermont, Virginia and Washington - had enacted laws or resolutions responding to or adjusting to the Medicare Rx law provisions.  

The 2008 Federal Poverty Guidelines, often termed the federal poverty level (FPL), were released January 23.  The new guideline for an individual is $10,400, a $190 increase from the 2007 figure of $10,210.  For a married couple or 2-person household the 2008 figure is $14,000.  Higher figures apply for Alaska and Hawaii.  For winter 2008, most figures listed in the tables below may use 2007 figures, still used for calculations in some state programs. 

SUMMARY OF STATE PHARMACEUTICAL ASSISTANCE PROGRAMS, 2007-08

KEY: = Operational  |= Recent, Not Operational  | = Not Operational Dates indicate earliest enacted law.  Click on Rx button for details

State	Subsidy Program	State Medicare Wrap Around	Discount Program	Notes
Alabama
Alaska	2004	2006		see 2007 change
Arizona	2001	2006	2003
Arkansas	2001		2005
California	.	special	'00'06
Colorado			2007	began 2/08
Connecticut	1986	2005	2000
Delaware	2000	2005
Florida	2000-05	special	2000, 2008
Georgia
Hawaii		2005	2002
Idaho
Illinois	1985	2005	2005
Indiana	2000	2005
Iowa			2001-05
Kansas	2000		2006	.
Kentucky	2005	2005
Maine	1975, 05	2006	2000
Maryland	1979	2005	2001,06
Massachusetts	1996, 02	2005, '06	1999, 05
Michigan	1988-05			ended 12/31/05
Minnesota	1997-05			ended 12/31/05
Mississippi
Missouri	1999	2005
Montana	2005	2005	2005
Nebraska
Nevada	1999	2005
New Hampshire			2000
New Jersey	1975	2005
New Mexico	2003		2002, '05
New York	1987	2005
North Carolina	1999	2006
Ohio			2002
Oklahoma			2005
Oregon	2001		2003,06
Pennsylvania	1984	2006
Rhode Island	1985	2006	2004
South Carolina		2005	2003
South Dakota			2003
Tennessee	2003, 2006		2006
Texas	.	special	2000
Utah
Vermont	1989	2005	2000
Virginia		special
Washington	2003	2006	2007
West Virginia			2000
Wisconsin	2001	2001, 07
Wyoming	1988
DISTRICT/ TERRITORIES
District of Columbia			2004
Virgin Islands		2005

MAP 1:  Snapshot of State Rx Subsidy Programs (SPAPs) , 2007-08 

Map 2:  State Wrap Around and Coordination Features, 2007-08

Table #1: State Subsidy Programs - provides brief details on each of the individual state programs, including citations and web links to state laws where available, year of creation, basic eligibility requirements and contact telephone numbers within each state for further details.  Also see further explanations and notes in Recent Major State Actions, below.
Table #2: State Discount Programs - Includes state-negotiated price reductions, discount cards and multi-agency purchase arrangements affecting segments of the public. Note that several states have more than one program.

Information is added to these charts when bills are passed. Further details for many states are included below under "Recent Major Actions".
Also see NCSL's other research reports:
* Pharmaceuticals Overview - recent activities and list of NCSL publications.
* Recent Medicaid Prescription Drug Laws, 2001-08 - describes state Medicaid-only laws, not included in this report.
* 2008 Prescription Drug State Legislation - covers current year bills on discount, subsidy, bulk purchase and cost containment - updated regularly.

State Subsidy Programs - TABLE 1

ALASKA	1) Senior Care Prescription Drug Benefit Program 2) The Senior Benefits Program (as of 8/1/07)
Alaska was one of six states to create a first-time pharmaceutical subsidy program after the enactment of the Medicare Part D benefit.  As such, it was intended primarily as a supplemental, wrap around benefit, aimed only at residents aged 65 and over, with incomes up to 175% of Alaska’s special FPL.  The law authorized the state to pay premiums and deductibles toward Part D plan costs or toward equivalent insurance premiums.  The program was revised, effective August 1, 2007, to provide a cash benefits instead of a Medicare contribution.
Eligibility, Fees	The Senior Benefits Program started Aug. 1, 2007, serving residents up to age 65.  The new cash benefit program for Alaska enrollees offers three different benefit levels based on annual income -- See table under Benefits, below.  The program no longer directly pays Medicare or insurance premiums.  Enrollees receive a cash benefit, which many use for pharmaceutical coverage, but may now use for other needed purchases.
Disabilities coverage	No coverage for residents under age 65.
Benefits	2008 Annual gross income limit (adjusted to Alaska's special federal poverty guideline): Household:  $250 monthly payment  $175 monthly payment  $125 monthly payment  Individual    $9,750  $13,000  $22,750 (175% FPL)  Couple  $13,125  $17,500  $30,625 (175% FPL) Note: From 1/1/06 to 7/31/07 the SeniorCare Prescription Drug Assistance program covered annual premiums and deductible for Medicare Part D or comparable Prescription Drug insurance; average value: $736. For income limit is $20,913 for an individual and $28,053 for a 2-person household.  (based on 2005 FPL, as of 1/1/08)
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP. (as of July 1, 2007).  The Senior Benefits Program funds spend on Rx should also qualify, but the program itself may not be considered qualified.
Est. # of beneficiaries	7,112 enrolled in the Cash Assistance program ($120/month subsidy) as of 7/1/06.  122 enrolled in Prescription Drug Assistance program as of 7/1/06.
State laws	Subsidy law initially enacted in 2004; Wrap around enacted in HB 106, as Chapter 89, signed August 8, 2005.  2007: SB 4 Extends the Senior Care cash assistance program, but repealed the existing stand-alone Rx wrap around benefit. Signed into law as 1st Special Session. Chapter 1, 8/2/07
Special features & issues	Parts of the SeniorCare program sunset in June 2007 unless extended by the legislature.  Annual funding is subject to available funds and legislative appropriations.
Other Rx programs	SeniorCare Cash Assistance can be used for Medicare co-pays, non-covered Rx products, or non-health needs such as housing or food.
Contact & online information	Alaska Department of Health and Social Services  Beneficiary contacts: 1-800-478-6065; (907) 269-3680. SeniorCare beneficiary contacts: 1-888-352-4150 or (907) 352-4150; Fax: 907-373-1136 Policy & Admin. contact: Jon Sherwood (907) 465-5820. Web: http://www.hss.state.ak.us/dsds/seniorInfoOffice.htm

Sources: NCSL summary of law                                     Updated: 2/2007, 2/4/2008

ARIZONA	Medicare Co-payment plan
In mid-2006, the FY 2006-2007 budget bill included a $1.5 million appropriation for payment of Part D co-pays for dual eligible enrollees, including acute, long-term care and behavioral health, administered by AHCCCS, the Medicaid agency.  "The intent of the Legislature is that all Part D co-payments will be covered as a state subsidy."  Program began October 1, 2006.
Eligibility	State resident Medicaid-Medicare dual-eligibles; Annual income up to 200% FPL; individual = $20,800; 2-persons = $28,000 (2008 rate).  Medicare Part D enrollment is required but separate state enrollment in the co-payment plan is not required. The program became operational as of October 1, 2006.
Disabilities coverage	Only Medicaid-Medicare dual-eligibles.
Benefits	AHCCCS will pay for 100% of the $1 to $5 pharmaceutical copayments for residents enrolled in both Medicaid and Medicare.
Medicare Wrap Around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	Estimated eligible: 87,000  (9/2006)   Actual enrollment
State laws	HB 2863 of 2006, signed as Chapter 344, 6/21/06 - FY 2006-2007 budget bill includes $1.5 million appropriations
Special features & issues	No special enrollment is required for dual-eligibles once enrolled in Medicaid and Medicare.
Other Rx programs	Arizona also continues to offer the CoppeRx Card® Prescription Discount Program- see below
Contact & online information	Arizona Health Care Cost Containment System (AHCCCS)  Toll-free: 800-770-8014; policy: 602-417-4269 Website: http://azahcccs.gov/site/ http://www.azahcccs.gov/PublicNotices/PressReleases/PR_MedicarePartD.pdf (9/21/2006)

Sources: interview w/ Director 9/2006; AZ web site 2/2007                                 Updated: 2/2/2007

ARKANSAS

Not operational; not funded -- See Archive

CALIFORNIA	Genetically Handicapped Persons Program
This limited eligibility health program serves only persons diagnosed as genetically handicapped.  The program has been approved by CMS as a "Qualified SPAP."
Medicare wrap around	Yes; state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Contact & online information:	Web: http://www.dhcs.ca.gov/services/ghpp/Pages/default.aspx

 Sources: CMS list of Qualified SPAPs, 12/31/2006            Updated: 2/2008

CONNECTICUT	ConnPACE (Connecticut Pharmaceutical Assistance Contract to the Elderly and the Disabled)
Connecticut’s long-time subsidy program, ConnPACE, provides wrap around and coordinated benefits between ConnPACE and Medicare Part D, including allowing the state to apply on behalf of current state subsidy enrollees.  All enrollees eligible for Medicare must join Part D, with the state covering all premiums, all but $30 of the deductible, and costs above the Part D gap.
Eligibility, Fees	State residents 65 and older or  disabled age 18-64 with annual income up to  $23,700.  For couples, the income limit is $31,900 ($ effective 1/1/08, a 2.6% increase from 2007).  Must have “no other plan of insurance or assistance” except Medicare Part D.  An annual inflation adjustment is tied to Social Security income, to the nearest $100.  A $30 annual registration fee is required.
Disabilities coverage	Yes; ages 18-64 are eligible, including coverage during the 2-year waiting period for federal Medicare eligibility.
Benefits	The state pays 100% of the Part D premiums (average $370 year), plus all out-of-pocket coinsurance and deductible above the standard ConnPACE $30 annual fee and copayment requirement of $16.25 per prescription. There is no yearly dollar limit on the amount of prescriptions covered.  Effective July 2007, ConnPACE requires dispensing of generic medications when available and ‘prior authorization’ of brand-name medications in all Connecticut prescription drug assistance programs.
Medicare wrap around	Yes; state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.  Authorizes automatic application for low income subsidy benefit and state-initiated enrollment in Part D plans, with the state selecting a Part D plan designated by the Commissioner if a recipient has not done so.
Est. # of beneficiaries	42,431 enrolled (36,241 elderly + 5,773 disabled) 41,000 in Medicare Part D (6/30/07)
State laws	1986: Program established by CGL sec 17b-491 et seq. 2005: Public Act 05-280, signed June 27, 2005.
Special features & issues	For the fiscal year July1, 2006-June30, 2007, there was an average of 42,431 clients that received subsidized costs of $34,365,040 for 990,023 paid prescription claims through the ConnPACE Program, as well as Medicare Part D premium payments totaling $8,248,657. For the six-month period of Jan-Jun 2007, the ConnPACE Program subsidized the cost of 521,660 prescriptions totaling $14,635,235 for an average of 40,702 clients. 44 percent of prescription drugs paid for during this period were for generic products. In addition to the prescription benefit, the ConnPACE Program subsidized Medicare Part D premiums in the amount of $3.9 million for an average of 41,000 clients per month.   For comparison, in FY 2006. ConnPACE paid for 995,943 prescriptions costing $95,951,969 annually.        The Program covers products “that are not Part D drugs” as defined in the MMA, if the patient or prescriber appeals for an "exception."  The state payment rate “may be made at (A) the lowest price established” by a PDP for a preferred drug in the same class, with the beneficiary responsible for any higher balance; (B) the ConnPACE price if lower than the PDP price.   Provides that the applicant or recipient “shall appoint the (state) commissioner” for the purpose of appeals and denials.
Other Rx programs	California had a large discount pharmaceutical program serving Medicare enrollees, 2000-2006.  A new CA discount plan is scheduled to go into effect in February 2008.  See Rx Archive; also CA Children's Services program was certified as a CMS Qualified SPAP.
Contact & online information	Connecticut Department of Social Services, Pharmacy Unit, Medical Care Administration toll-free information: 1-(800) 423-5026;  (860) 832-9265; consumers: (860) 269-2029 Web: http://www.connpace.com/     |       ConnPACE & Medicare Rx ConnPACE Semi-Annual Report to the Governor (January to June 2007) [21 pages PDF]

Sources: NCSL summary of laws; 11/15/2006; ConnPACE Report (June 2007)                                   Updated:3/2008

DELAWARE	Delaware Prescription Drug Assistance Program (DPAP)
Delaware’s Rx subsidy program has established a wrap around benefit for Medicare enrollees, to cover premiums, deductibles and drugs purchased in the coverage gap over $2,400, up to a maximum of $2,500 in state funds per calendar year.
Eligibility	State residents, at least 65 years old or qualified for Social Security Disability benefits. Maximum annual income: up to 200% FPL; individual = $20,800. (2008 rate)  Couples are counted as two individuals.  In addition, individuals with income over 200% of FPL can qualify if they have prescription costs exceeding 40% of their income.  Requires that Medicare benefits be the primary source of benefits for those who are Medicare eligible.
Disabilities coverage	Yes; up to age 64 are eligible, including coverage during the 2-year waiting period for federal Medicare eligibility.
Benefits	DPAP will pay for premiums, deductibles and drugs purchased during the Medicare Part D coverage gap.  Enrollees must copay $5 or 25% of the cost of each prescription, whichever is greater; the state will not pay any portion of Medicare Part D copayments.  Example: An individual with $5,000 in prescription costs annually could receive $370 for premiums, $250 for the annual deductible and up to $1,880 for gap coverage for a total up to $2,500 annually in state funds.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	7,368 enrollees as of 7/2007; an estimated 95% are eligible for Medicare.
State laws	1999: SB 6; benefits and enrollment began in 2000; 2005: SB 18 established the wrap around program, effective January 1, 2006.
Special features & issues	The state law restricts covered drugs to those from manufacturers that agree to provide a drug rebate back to the state, based on Medicaid rebate methodology.  [NOTE: This rebate requirement is not consistent with the structure of Medicare PDP plans.]  May cover some drugs that are excluded from Part D that have received prior authorization, including OTC drugs, benzodiazepines and barbiturates.    Funding: Tobacco settlement funds.
Other Rx programs	Benefits are coordinated with the private Nemours Foundation prescription benefit; their enrollees are not eligible for DPAP.
Contact & online information	The Division of Social Services; Phone: 255-9500 or 1-800-372-2022; FAX: (302) 255-4454 Web: http://www.dhss.delaware.gov/dhss/dss/dpap.html

Sources: DPAP program materials 1/2007; NCSL summary of law                                     Updated: 2/2007

FLORIDA	Florida Comprehensive Health Association
This limited eligibility "high risk pool" served only persons denied health coverage elsewhere.  Enrollment has been closed for several years, but it has been approved by CMS as a "Qualified SPAP."

Sources: CMS list of Qualified SPAPs, 12/31/2006                          Updated: 2/2007

HAWAII	State Pharmacy Assistance Program
Hawaii authorized its first Rx subsidy program in July 2005.  The program is focused on Medicare eligible seniors and persons with disabilities only with income up to 100% of FPL. ($11,750 in '07).  It would assist eligible individuals "in defraying their cost" of prescriptions through a wrap around benefit within Medicare Part D.  The program is not operational.
Eligibility	Residents age 65 and over or disabled with annual income up to 100% of FPL  (Hawaii's special poverty guideline is $11,750 for individuals in 2007.)  The statute does not specify Medicare eligible as a state eligibility requirement. Enrollees must meet an asset test “as defined by the MMA”, and not be enrolled in a Medicare Advantage plan, a retired employee plan receiving a Medicare benefit payment, or any private sector plan or insurance paying for prescription drugs. Hawaii already uses 100% FPL as the Medicaid aged-disabled level, so few, if any, state benefits may be available to Medicare enrollees.  Program is not operational; the start date is not established.  [2/2008]
Disabilities coverage	Yes, if otherwise qualified.
Benefits	Extent of benefits not yet specified. The law specifies that the program “may pay all or some of the deductibles, co-insurance payments, premiums and copayments.” Most dual eligibles under 150% FPL will have limited financial obligations under Medicare Part D.  A senior not on Medicaid with income just under 100% FPL might receive coverage for copayments due on each purchase.
Medicare wrap around	Yes; state benefits are to be provided in coordination with federal Medicare.  Not a federally qualified SPAP (as of 12/06)
Est. # of beneficiaries	none enrolled.
State laws	2005: SB 802, signed on 7/8/05 as Act 209; authorized to be operational as of 1/1/06.
Special features & issues	The program may facilitate enrollment and coordination of benefits.    Legislative Note: The final Senate legislation to create an SPAP provided for coverage up to 150% of FPL.  A conference committee reduced that number to 100% FPL.   The manufacturer rebate feature, the funding source and the asset test may require reexamination to comply with CMS and PDP structures.   Funding: Earmarks all manufacturer rebates established by the 2005 Act (in sec. 346B(g)) for use by the new program.
Other Rx programs	Hawaii Rx+ discount program (on-line description)                                                   See related article (8/2/06)
Contact & online information	Department of Human Services.  Policy information only: (808) 692-8134

Sources: NCSL summary of law                                     Updated: 2/2007

ILLINOIS	1) Illinois Cares Rx Plus (formerly SeniorCare) 2) Illinois Cares Rx Basic (formerly Circuitbreaker)
A 2005 state law updated three existing state pharmacy assistance programs and created the “No Senior or Person with Disabilities Left Behind” plan as a Medicare wrap around that allows the state to pay premiums, deductibles and gap coverage for up to 241,000 seniors and persons with disabilities.  The state also continues coverage programs for non-Medicare adults.
Eligibility	Illinois Cares Rx Plus is available to residents age 65 or older, with income up to $19,600 for individuals or $26,400 for a married couple. (200% FPL as of 2/06).  Illinois Cares Rx Plus covers prescription drugs that were previously covered by SeniorCare. Illinois Cares Rx Basic is available up to $21,218 for individual, up to $28,480 for a couple (approximately 216% FPL), or up to $35,740 for a qualified household of three.  Medicare eligibility is not a requirement.
Disabilities coverage	Yes; up to age 64 are eligible, including coverage during the 2-year waiting period for federal Medicare eligibility.
Benefits	A senior with annual income above 150% of federal poverty with $5,000 in drug expenses could receive 100% of the standard Part D premium and deductible costs, including the 25% co-insurance and gap coverage, totaling about $3,000 in state-paid costs.  Coverage includes some drugs that are excluded from federal Medicare coverage such as benzodiazepines.
Medicare wrap around	Yes; most state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	247,592 enrollees as of 6/30/06.
State laws	2005: SB 973, signed 6/29/05; effective 1/1/06. IL also had a Pharmacy Plus Medicaid 1115 waiver for residents under 200% FPL.
Special features & issues	State law authorizes auto-assignment; 2005 state enrollees will be automatically enrolled in wrap around features, with one application for all programs; the state will use its preferred drug list where applicable.  The state’s Pharmacy Plus 1115 waiver presents special conditions for some enrollees under 200% of FPL.  IL has two qualified SPAPs for TrOOP calculations.  Enrollees with incomes between 200% and 225% of FPL are covered only for drugs for treatment of 11 conditions including: Alzheimer’s, arthritis, cancer, diabetes, glaucoma, cardiovascular disease, lung and smoking-related diseases, osteoporosis, Parkinson’s or multiple sclerosis.        All Illinois Cares Rx clients enrolled in a PDP must follow their PDP’s formulary. "Illinois Cares Rx will not cover Part D covered drugs just because they are not on the client’s PDP’s formulary."       People with Original Medicare must apply for Low Income Subsidy (“Extra Help”) and must enroll in one of two Medicare prescription drug plans coordinating with Illinois Cares Rx: PacifiCare Saver Plan or the AARP Medicare Rx of United HealthCare Insurance Company. Governor’s Administrative Initiatives: (as of January 2008) with SB 5 stalled in the Senate, the Governor has used his executive authority to expand health coverage.  The Governor has said the following: “Unfortunately, the Illinois General Assembly failed to act on expanding access to healthcare this session. In the face of that inaction, I am using my executive authority to expand healthcare to over 500,000 more Illinoisans.”  As a result, in the summer of 2007, Gov. Blagojevich announced that he planned to use his executive authority to implement five initiatives, some of which were part of Illinois Covered (SB5).  Included is Assist Primary Care, Rx, Hospital: This program would provide a medical home, prescription drugs and hospital reimbursements for those without access under 100% of the Federal Poverty Level. The Governor has initiated “All Kids Bridge” program and an expansion of “Family Care,” despite having no statutory authorization, and despite the disapproval of the Joint Committee on Administrative Rules of proposed rules attempting to implement the Family Care expansion. A lawsuit is pending challenging the Governor’s authority, but the program has been enrolling families in the meantime. (1/08)
Other Rx programs	Discount Program: Illinois Rx Buying Club Member Services.   Tel. Toll-free 866-215-3462;  (TTY) 866-215-3479 http://www.illinoisrxbuyingclub.com/ Illinois Covered Assist: A state program focused on access to primary care and disease management for those who are very low-income—under 100% of the federal poverty level (FPL) (currently a single person who makes less than $10,210 annually, or a couple making less than $13,690 annually)—and who do not have health insurance or access to current Medicaid programs.  Assist will provide access to a medical home through a community health center, a prescription drug benefit, and reimburse hospitals for non-elective in-patient services for Assist beneficiaries.
Contact & online information	Telephone 217 524-0084;  toll-free in IL: 800 624-2459 http://www.illinoiscaresrx.com/ ; http://www.cbrx.il.gov/

Source: State web site, conversation with IL House.   Updated: 1/22/2008

INDIANA	HoosierRx
The Hoosier Rx program, founded in 2000, continues in 2007.  The current structure provides up to $1,200 per year  for seniors age 65 and over with annual incomes up to 150 percent of federal poverty guidelines.  The program now offers wrap around benefits for Medicare PDP monthly premiums for plans working with HoosierRx .
Eligibility	Must be a resident, age 65 and older, have Medicare Part A and/or Part B, and have a yearly income up to, $15,840 or less for a single person, or $21,240 or less for a married couple living together.  (Approximately 152% FPL for 2008)  Participants must enroll in one of the Medicare Prescription Drug Plans working with HoosierRx.  Participants must apply with the Social Security Administration for extra help from Medicare.  HoosierRx can assist those that get partial extra help from Medicare and those denied for Medicare’s extra help due to resources.
Disabilities coverage	Persons with disabilities under age 65 are not eligible for state benefits, as of 11/05.
Benefits	HoosierRx will help low-income seniors make up the difference between their out-of-pocket costs and the Medicare coverage.  For individuals with partial Medicare extra help, HoosierRx "can help pay the monthly Part D premium, up to $70 per month," that is not covered by Medicare, within one of the plans that are working with HoosierRx.   For individuals with no Medicare extra help, HoosierRx will pay the monthly premium of one of the nine plans working with HoosierRx: AARP/United Healthcare, CIGNA Healthcare, Coventry AdvantraRx, First Health, Humana, MemberHealth, Prescription Pathway, SilverScript and WellCare. [2008 list]
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	2,300 enrollees as of 7/2007 (no non-Medicare, no full dual-eligibles).
State laws	HB 1251; HB 1325 (2005), also IN Admin. Code, Title 405, Art. 6
Special features & issues	HB 1325 seeks coverage for Medicare deductibles, premiums and drug costs not covered by the federal benefit or federal PDP plans. HoosierRx currently does not require the use of prior authorization, preferred drug lists or mandatory generics.    The 2005 law authorizes future coverage up to 200 percent of federal poverty if recommended and approved.  HoosierRx has restructured the program and, as of 7/1/06, there is no more wrap around benefit ($250 for co-pays and premium).  HoosierRx will now pay a higher premium amount for enrollees instead of using the wrap around benefit.       Funding:  Money from the Tobacco Settlement Fund has been allotted for this program, it does not receive Indiana General Fund dollars. State legislators will have to approve a budget that includes money allotted to this program for its continuation. [2/08]
Other Rx programs	"Rx for Indiana" is a separate "collaborative effort by Gov. Mitch Daniels, local and statewide organizations and the pharmaceutical industry" and is not a subsidy program, but rather a clearinghouse that pulls together all federal, state and private companies that offer discounted drugs and services.  Rx for Indiana helps people of all ages find and apply for assistance through pharmaceutical manufacturers for help with brand name drugs.  Each company program has different benefits and covers different drugs, providing free or discounted prescription drugs to eligible patients.  As of 7/11/06, the Rx for Indiana telephone hotline logged 76,649 calls and the website logged 99,148 hits.  141,592 patients initially qualified for assistance and approximately 81% were eventually matched to a program.
Contact & online information	Hoosier Rx Program (toll free) at 1-866-267-4679 Senior Health Insurance Information Program counselors (toll-free) at 1-800-452-4800. Subsidy program: http://www.in.gov/fssa/ompp/4248.htm  [2/08] Clearinghouse: http://www.rxforindiana.org/

Sources: Hoosier Rx website (3/4/2008); Interview with Governor's office 12/29/2005; HB 1325; HB 1251; IAC Title 405, Art. 6; e-mail and telephone correspondence with Brian Smith, PhRMA.         Updated: 7/17/2007, 3/4/2008.     

KANSAS	Medicare-Medicaid dual-eligible Copayment plan
The Kansas Medicaid program is reported to pay limited state assistance with the cost of copayments to Medicare-Medicaid dual-eligible enrollees*
Eligibility	Medicaid dual-eligibles under 135% of federal poverty. ($14,040 for an individual; 2008 FPL rate)
Disabilities coverage	.
Benefits	Medicaid will pay the $1 to $5 Rx copayments.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	.
State laws	Kansas Medicaid agency
Special features & issues	The terms of this limited benefit were first reported by NASMD in November 2006.*  Other details are not available at the time of this update or have not been confirmed by NCSL.
Other Rx programs	Kansas also offer the Kansas Community RX program, see below
Contact & online information	Kansas Medical Assistance, http://www.srskansas.org/ISD/ees/eanddmedical.htm

Source: * National Association of State Medicaid Directors (NASMD) report, "State Perspectives on Emerging Medicaid Pharmacy Policies and Practices" 11/06.     Updated: 11/15/2006

KENTUCKY	Kentucky Pharmaceutical Assistance Program
Kentucky passed a 2005 law to implement a state pharmaceutical assistance program.  However, it has not been implemented. The state intended to contract with a third party, to direct dual or lower income beneficiaries into the state preferred plan. The contractor would negotiate for drug rebates.  However, CMS clarified that these types of arrangements did not meet the criteria of an SPAP under Medicare.  Kentucky has not moved forward with the SPAP as of mid-2007.
Eligibility	Includes persons 65 or older or disabled and enrolled in Medicare, with a household income up to 150% of the poverty level, meeting the asset test, and not having other prescription drug coverage.
Disabilities coverage	Yes, as described above.
Benefits	This program is not operational as of fall 2007 and the start date is not yet established.
Medicare wrap around	Yes; all state benefits are intended to be provided in coordination with federal Medicare.  Currently not a Qualified SPAP; payments would not count toward TrOOP.
Est. # of beneficiaries	none enrolled
State laws	2005: SB 23 signed into law March 18, 2005
Special features & issues	Would allow the Department of Medicaid Services to determine drugs to be covered by the plan, and allow department to negotiate with manufacturers for rebates. Features not approved by CMS in 2005 prevented implementation.  The legislature likely will review such terms and conditions.
Other Rx programs	.
Contact & online information	Not available; not yet operational. Department of Medicaid Services

Updated: 1/1/2006

MAINE	Low Cost Drugs for the Elderly and Disabled Program
Maine has run one or more senior pharmacy assistance programs since 1975.   For 2006, the state will offer wrap around benefits for Medicare eligibles, including coverage for premiums, one-half of the deductible and 80% of the coverage gap.
Eligibility	For subsidized benefits: Maine residents age 62 and older, or persons with disabilities age 19-61, with annual income of 185%  ($19,240 for 2008).  If a person spends 40% of yearly income on prescription drugs, the income limit is 200% FPL.  ($20,800 for 2008)
Disabilities coverage	Persons with disabilities under age 65 are eligible for state benefits, including coverage during the 2-year waiting period for federal Medicare eligibility.
Benefits	Wrap around benefits apply to dual eligibles & three levels based on income.  Some pharmaceuticals excluded by Medicare will continue to be covered for everyone, as covered in 2005. The state will pay 1/2 of the copay up to $10 - $15 for all dual eligibles.  For those in assisted living, the state will pay 100% of all copays.  The program has eliminated its asset limit, which will qualify an estimated 9,000 new residents.  Those residents for whom the state pays Part B Medicare premiums, the state also will now cover Part D premiums.  Copays are covered 50% with a cap of $10; also will cover 100% premium; 50% of deductible; and 80% of the coverage gap (doughnut hole), for the 14 categories of treatments specified in state law.  Enrollees pay 20% of the coverage gap (over $2,250).
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	86,000 (47,876 are Dual Eligible; 38,133 are non-Dual or non-Medicare)  7/2007
State laws	2005: LB 1325, signed by governor as Chapter 401, 6/17/2005; State agency given emergency regulatory authority
Special features & issues	The Department of Human Services has emergency regulatory authority to make further adjustments in benefits and eligibility. In April '06, a Supplemental Budget was enacted with broad bipartisan support. It includes $10.7 million to ensure that seniors who received prescription drug benefits under MaineCare or the state’s Drugs for the Elderly program would not lose benefits or have to pay more because they were switched to the federal Medicare Part D program. The budget provides extensive ongoing wraparound benefit for Medicare Part D enrollees including both Medicaid dual eligibles and participants in the state elderly low-cost drug program members who are transitioning to Medicare Part D. Also provides for the state purchase of a higher than benchmark plan when a person needs a drug that is not on their plan's formulary and they have an initial denial of an exception for coverage; eliminates all co-payments for persons in all levels of private non-medical institutions (boarding and group homes); and eliminates all co-pays on generics.   MSP program-asset test converted 9,000 enrollees.
Other Rx programs	Yes, Maine Rx Plus Discount Plan, see below
Contact & online information	Tel.: 207 287-2674; toll-free: 888 600-2466 http://www.maine.gov/dhhs/beas/medbook.htm

Sources: Chapter 401 of 2005; Interview with Jude Walsh, Maine Special Asst for RX, 6/2007.           Updated: 6/1/2007

MARYLAND	Maryland Senior Prescription Drug Assistance Program (SPDAP) Primary Care Program
Maryland has provided some state Rx assistance since 1979.  A 2005 law integrated previous state programs by providing Medicare Part D beneficiaries who meet program requirements with a state subsidy authorized for a portion of their Medicare Part D premiums, deductibles, coinsurance payments, and/or copayments.   For 2008 the benefit covers up to $25 of the monthly premiums.
Eligibility	2005 members grandfathered in as of 12/31/05.  Resident for 6 months; at or below 300% FPL ($31,200 for individual, based on 2008 rate) and enrolled in Medicare; but must not be qualified for full federal "extra help" LIS benefit.
Disabilities coverage	Persons with disabilities under age 65 are eligible for state benefits, including coverage during the 2-year waiting period for federal Medicare eligibility.
Benefits	Successful applicants can receive up to $25 per month ($300 annually) towards the cost of their monthly Medicare Rx or Medicare Advantage Prescription Drug premium.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	35,500 enrollees, as of 7/1/06
State laws	2005: HB 324 & SB 282, enacted into law May 2005.  Authorizes a state subsidy  for a portion of their Medicare Part D premiums, deductibles, coinsurance payments, and/or copayments.
Special features & issues	1) The MD discount and subsidy programs of 2005 were folded into the new Primary Care Program.  The new Primary Care Program was authorized under Maryland's revised 1115 waiver renewed earlier this year.  People enrolled now get prescription drugs and more replacing need for a separate drug program. Maryland also has an Rx discount plan, changed as of 1/1/06 to serve non-Medicare residents, mostly under age 65. 2) The Maryland Pharmacy Program (MPP) Provides services for the following programs: Medicaid, HealthChoice receive most mental drugs; all other drugs are provided by HealthChoice Managed Care Organizations (MCOs);  Primary Adult Care (PAC); Family Planning receive only contraceptives and Medicare Part D fully dual eligible Medicare beneficiaries receive most drugs excluded from Medicare Coverage. 3) SPDAP will attempt to coordinate with an individuals' selected Medicare Rx or Medicare Advantage plan for the direct subsidy of the monthly premium, so that enrollees are only billed by the Medicare plan for any premium which exceeds the state’s monthly subsidy of $25.   During the 2006 session, the Maryland Legislature passed HB 702, which prohibits the subsidy required under the Senior Prescription Drug Assistance Program from exceeding a specified amount in specified fiscal years.  The bill also authorizes a subsidy for copayments and deductibles.
Other Rx programs	Yes, see MD Discount plan below
Contact & online information	To request an application, call the Maryland Pharmacy Program toll-free, 1-800-226-2142 SPDAP program: http://www.marylandspdap.com/ The Maryland Medicaid Pharmacy Program (MPP): www.dhmh.state.md.us/mma/mpap/ Application and income: download application Maryland SPDAP, c/o Pool Administrators, 100 Great Meadow Rd, Suite 705, Wethersfield, CT  06109

Updated: 12/15/2005, 2/21/2008.
Sources:  Text of MD 2005 law; Interview with MD Program Plan Analyst 12/2005; interview with Chris Coats, Maryland Medicaid 7/18/06.

MASSACHUSETTS	Prescription Advantage
Massachusetts is one of two states which had a sliding-scale subsidized prescription insurance plan, with no income limit for seniors but with a low-income limit for persons with disabilities.  The recently authorized wrap around begun in 2006 makes Medicare Part D the required primary coverage, with state help for deductible, copayment and coverage gap payments. The state was the first to gain approval in 2005 for automatic enrollment in Part D on a random basis.
Eligibility	Open to all non-Medicaid seniors age 65 and older of all incomes, and low income persons with disabilities (see below).  No asset test.  For persons with Medicare, income limit is up to 500% FPL; without Medicare, there is no income limit.  Prescription Advantage will continue to offer prescription drug insurance coverage for people not eligible for Medicare.
Disabilities coverage	Persons with disabilities under age 65 with a special maximum income of 188% FPL and not more than 40 work hours per month are eligible for state benefits, including coverage during the 2-year waiting period for federal Medicare eligibility.
Benefits	The state will help pay deductible, copayment and coverage gap payments, with at least four categories of income levels receiving sliding scale financial benefits. The details are not specified in statute.  Examples: > Full duals (under 135% FPL) will not receive state help. > Between 135%-188% FPL: state pays premiums up to $363.24 annually and copays above $7 generic or $18 brand-name.  Out-of pocket expenses capped at $1,300 to $1,440. > Between 188%-225% FPL: State pays premium share up to $123 annually and copays above $12 generic or $30 brand-name.  Out of pocket expenses capped at $1,800 annually. > Between 225% FPL-300% FPL: State pays only copays above $12 generic or $30 brand-name.  Out of pocket expenses capped at $2,150 annually. > Between 300%-500% FPL: State may provide gap coverage after a cap of $2,870.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	Total enrollment in Prescription Advantage is 68,364 as of 7/2007. Estimated 70,229 eligible for Medicare; 774 are non-Medicare.
State laws	MGL Ch. 19A, §39 H 4200, §27 signed into law by governor as Chapter 45 of 2005 on 6/30/05. Chapter 175 of 2005 signed into law by governor on 12/30/05 H 5000 of 2006 signed into law by governor on 7/8/06
Special features & issues	On August 29, 2005, CMS formally approved the Massachusetts plan to automatically enroll state members into lower cost drug plans, with 5 plans initially approved for this process. Members in “Medicare Advantage” plans (Tufts, Fallon, Harvard Pilgrim and Blue Cross) will not be automatically enrolled.  Prescription Advantage will pay for benzodiazepines (excluded from Medicare coverage) but will not cover other drugs excluded from Medicare coverage, such as barbiturates and over-the-counter drugs. The multi-level sliding scale benefits may be examined to simplify the structure.  The state-only insurance product for the much smaller pool of 3,000 people may be subject to evaluation as well.
Other Rx programs	MassMedLine is a free, confidential pharmaceutical information clearinghouse available to all Massachusetts residents who are seeking information regarding their medications. Using the toll-free help line, 1-866-633-1617, residents can speak to pharmacists and case managers one-on-one to receive personal assistance with pharmacy related questions or finding programs to help with the cost of medications.  The program was created in a law (now MGL Chapter 19A, sec. 4C) passed by Sen. Richard Moore in 2000. Website: http://www.massmedline.com | Spanish language site.
Contact & online information	MA Executive Office of Elder Affairs; 617 727-7750 Prescription Advantage Customer Service - toll-free: 800 243-4636. http://www.mass.gov/Eelders/docs/prescription_advantage_medicare_wrap_factsheet.pdf ; http://www.mass.gov/portal/site/massgovportal/menuitem.db805ceae7e631c14db4a11030468a0c/? pageID=elderssubtopic&L=3&L0=Home&L1=Health+Care&L2=Prescription+ Advantage&sid=Eelders

Updated: 7/28/2006, 5/2007
Source:  presentation by Beth Waldman, MA Medicaid 6/7/2005; CMS statement 8/29/05; websites of EOEA 12/2005; e-mail correspondence with Randy Garten, Dir. of Prescription Advantage (Exec. Office of Elder Affairs) 7/28/2006.

MISSOURI	"MoRx"; Missouri Rx Plan  (replaced Missouri Senior Rx)
Missouri's 2005 law coordinates state pharmaceutical assistance with MMA.  It establishes a newly defined "Missouri RX" subsidy plan for residents with income up to 200% of federal poverty. The Plan "may pay all or some of the deductibles, coinsurance, payments, premiums and copayments" required by Part D; the state may select one or more preferred PDP plans for purposes of the coordination of benefits between the program and the Medicare Part D drug benefit. Beginning 2006, Medicare disabled under 65 were added as eligible.
Eligibility	For 2007, residents with income up to 200% of federal poverty or dual-eligibles.  In 2006, residents with maximum income up to 150% of federal poverty or dual-eligibles. The old Senior Rx Program members and all dual eligibles (eligible for both Medicare and Medicaid) were automatically enrolled into MoRx. There is no cost for this enrollment, nor is there any additional paperwork. To receive the benefits of the MoRx program, its members must be enrolled in a Medicare Prescription Drug Plan. Non-duals must not be enrolled in Medicaid.
Disabilities coverage	As of 2006 persons with disabilities under age 65 are eligible for state benefits, once they fully qualify for Medicare after the federal two-year waiting period.
Benefits	"MoRx pays for 50% of members' out of pocket costs remaining after their Medicare Prescription Drug Plan pays. It pays for 50% of the deductible, 50% of the co-pays before the coverage gap, 50% of the coverage gap, and 50% of the co-pays in the catastrophic coverage."
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	172,000 as of 7/2007. 148,348 are dual-eligibles transferred from State Medicaid Program in 2006; 13,297 were members of former program called Missouri Senior Rx (auto-enrolled into Missouri Rx Program)
State laws	2005: SB 539 was signed into law by governor on April 26, 2005. The old “Senior Rx Plan” is being phased out as soon as the MMA Part D benefit is “fully implemented” as certified by the state.
Special features & issues	The new Missouri Rx Plan will no longer require an enrollment fee or deductible. It will provide "wrap around" coverage to those who have Medicare A and/or B and are enrolled in a Medicare Rx Prescription Drug plan. Missouri Rx benefits will help pay a percentage of member's out of pocket drug costs remaining after using their Medicare Rx Prescription Drug plan. 2005 enrollees over 150% FPL were expected to transfer to a federal-only benefit plan in 2006, where the costs of benefits will be somewhat similar to their old benefit, with higher premium but 25% copay instead of 40%.  On November 1, 2006, Governor Blunt announced expansion to cover residents up to 200% of FPL.
Other Rx programs	.
Contact & online information	Missouri Rx, 205 Jefferson Street, Room 1310, Jefferson City, MO 65101 Telephone: 1-800-375-1406 (Toll-free) http://www.dss.missouri.gov/dms/pharmacy/mo_rx.htm News: "Blunt announces expansion of Missouri Rx program" 11/1/06.

Sources: MO legislative and agency web sites, 12/2005; telephone conversation with Jerry Simons, Executive Director of Missouri Rx Plan.  Updated: 11/2/2006

MONTANA	Big Sky Rx Program
This newly created state program is designed to help qualified Medicare residents pay for Medicare prescription drug premiums, up to $397 annually.
Eligibility	MT Resident, enrolled in Medicare Part D plan, with annual family income less than about $19,600 if single or about $26,400 if married and living together. (200% FPL in 2006.)  Also requires enrollees to have applied for Extra Help if annual family income is less than $14,700 if single or $19,800 if married and living together. Big Sky Rx will inform applicants when they appear close to being eligible for Extra Help.
Disabilities coverage	As of 2006 persons with disabilities under age 65 are eligible for state benefits, once they fully qualify for Medicare after the federal two-year waiting period.
Benefits	Pays up to $33.11 of Medicare Part D premium, for an annual maximum of $397.00.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	4,031 as of 7/2007.
State laws	2005: SB 324, signed into law as Chapter 282 of 2005, 5/10/05.
Special features & issues	funded by the tobacco tax revenue.  Concerned about growth factor in premiums and other unknowns.
Other Rx programs	Yes, Montana PharmAssist Program, see below
Contact & online information	Brochure: http://www.dphhs.mt.gov/prescriptiondrug/applicationcover.pdf or http://www.dphhs.mt.gov/prescriptiondrug/bigskyrxbrochurefinal.pdf Application: http://www.dphhs.mt.gov/prescriptiondrug/bigskyrxapplication.pdf Homepage: http://www.bigskyrx.mt.gov/

Updated:  7/18/2006
Sources:  Website; interview with Bureau Chief; interview with Gayle Shirley, MT Public Information Office 7/18/0206.

NEBRASKA	Medicare-Medicaid dual-eligible Copayment plan
The Nebraska Medicaid program is reported to pay limited state assistance with the cost of copayments to Medicare-Medicaid dual-eligible enrollees*
Eligibility	Medicaid dual-eligibles under 135% of federal poverty.
Disabilities coverage	Yes, for Medicaid dual-eligibles.
Benefits	Medicaid will pay the $1 to $5 Rx copayments.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	*
State laws	Nebraska Medicaid agency
Special features & issues	The terms of this limited benefit were first reported by NASMD's November 2006 report.*  Other details are not available at the time of this update or have not been confirmed by NCSL.
Other Rx programs	.
Contact & online information	Nebraska Medicaid, http://www.hhs.state.ne.us/med/medindex.htm

Updated: 11/06
Source: * National Association of State Medicaid Directors (NASMD) report, "State Perspectives on Emerging Medicaid Pharmacy Policies and Practices" 11/06. 

NEVADA	1) Nevada Senior Rx 2) Nevada Disability Rx
Nevada’s first-in-the-nation state-negotiated Rx insurance subsidy program was one model for the federal Medicare benefit, with its reliance on private insurers.  State law enacted in 2005 requires the state to wrap around and coordinate prescription drug services provided by the state with those provided by Medicare, with a goal of maintaining present coverage "to the extent allowed by federal law," as well as maximizing prescription drug coverage and the use of federal funds.
Eligibility	Senior Rx is available for residents age 62 or older at the time of application with annual income not more than $24,118 for individual or $31,396 for a married household (figures effective July 1, 2006.) Disability Rx is available for residents age 18-61 with annual income not more than $24,118 for individual or $31,396 for a married household (figures effective July 1, 2006.) For those eligible for Medicare, Senior Rx and Disability Rx will help pay for Part D PDP premiums and prescription drug costs after Part D coverage limit is reached.  For those not eligible for Medicare, there is no monthly premium, no deductible, drug coverage of $10 for generics and $25 for brand, and an annual coverage limit of $5,100.  The State provides assistance with Medicare Part D expenses for members who are eligible for Part D and a cost-sharing benefit for members who are not eligible for Part D.
Disabilities coverage	Persons with disabilities under age 65 are eligible for state benefits, including coverage during the 2-year waiting period for federal Medicare eligibility.
Benefits	The state will pay up to $281.52 annually toward annual Part D premiums (100% of $23.46/month for a basic plan) and will provide gap coverage for 100% of the expenditures over $2250 /per year (a state contribution up to $2,850).  Maximum annual state benefit = $5,100.00.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	5,756 enrolled in Senior Rx as of 7/2007 526 active enrollees in Disability Rx
State laws	2005:  AB 495 and AB 524 enacted and signed June 10, 2005
Special features & issues	The department may waive the eligibility requirements for an individual based on income, disability or extreme financial hardship, certified in a written request.  State-only insurance policies remain available for non-Medicare enrollees.  For 2006 only there may be a special emergency fund to assist with deductibles.  “We want to make sure no one is worse off” said Mike Willden, Director of Health and Human Services. The legislature requested a departmental report by 11/05 regarding the state amount for premium payments. The state program continues to serve a small population of non-Medicare residents (age 62-64 or with certain disabilities) with an insurance policy product. [NOTE: A Notice to members on the NV website states that deductibles and copayments will not be paid.]
Other Rx programs	.
Contact & online information	http://nevadaseniorrx.nv.gov/

Updated: 7/21/2006; 5/2007
Sources:  Senior Rx website; text of Nevada law; statement by Department  7/21/2006

NEW HAMPSHIRE	N.H. Pharmaceutical Assistance Program
New Hampshire created its first SPAP in 2005, specifically designed to wrap around Medicare Part D, aimed at duals and non-duals up to 150 percent of federal poverty.  The program will be authorized to pay all or some of the deductibles, coinsurance, premiums and copayments, and products not covered by Medicare.   The program is not yet in effect, pending implementation approval by a legislative fiscal committee and CMS.
Eligibility	Age 65 or older or disabled and receiving Social Security and enrolled in Medicare, with household income up to 150% of FPL and meeting the asset test.  Medicaid dual eligibles receive initial enrollment priority.  90-day state residence required.
Disabilities coverage	As of 2006, persons with disabilities under age 65 are eligible for state benefits, once they fully qualify for Medicare after the federal two-year waiting period.
Benefits	This program is not operational as of fall 2007. The details of the state share to "pay all or some of the deductibles, coinsurance, premiums and copayments, and products not covered by Medicare" are not yet available. NOTE: As of January 1, 2006 the NH Medicaid program will provide coverage for pharmaceuticals not covered by Medicare, only for dual-eligibles.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	n/a
State laws	2005: SB 163, signed as Chapter 294 of 2005 on July 26, 2005
Special features & issues	The program was intended to launch January 1, 2006. Wrap around coverage “shall be provided” for prescription drugs excluded from definition of Medicare Part D drugs, but are covered by Medicaid. The law provides that the state “may” require Medicaid-level rebates, and enroll beneficiaries into a preferred Medicare Part D plan. (These provisions have not been approved for implementation by the NH Fiscal Committee or by CMS nationally). The entire program requires final "sign-off" by the legislature's Fiscal Committee, and CMS. The asset test is not defined in state law. The level or degree of state contribution per enrollee is not stated in law.  The preferred PDP and rebate language is inconsistent with CMS requirements as of 11/05.
Other Rx programs	In 2000 the Governor's Executive Council authorized a pharmaceutical discount program for seniors, which operated for four years under a state contract.  By 2005 the state ceased to play a role in the operation of the program, although it continued under the administration of a private company.
Contact & online information	Not yet operational. NH Office of Medicaid Business and Policy is 603-271-5254 [no online information as of 1/2008]

Updated: 12/22/2005; 2/2008 |  Sources: NH SB 163/Chapter 294; communication with Don Hunter, NH Medicaid 12/22/2005

NEW JERSEY	1) PAAD - Pharmaceutical Assistance for the Aged and Disabled 2) Senior Gold
New Jersey's two operational pharmacy assistance programs served over 200,000 resident in 2005, and celebrated a 30th anniversary since they enacted their original, first-in-the nation senior program in 1975.   For 2006, N.J. requires that Medicare eligibles enroll in a Part D plan, with the state covering cost-sharing, deductibles and coverage gap costs in Medicare Part D, as well as premiums for those eligible for PAAD.
Eligibility	Age 65 or older or over 18 and disabled receiving SSDI benefits.  PAAD: Income up to $21,850 for an individual (approximately 214% of FPL in 2007) and up to $26,791 for a couple (196% of FPL in 2007).  PAAD beneficiaries are also required to enroll in a Medicare Part D Prescription Drug Plan.  They will not have to pay premiums, deductibles, or any out-of-pocket costs beyond the regular PAAD $5.00 co-payment. Senior Gold: Income between $21,850 and $31,850 annually for an individual and between $26,791 and $36,791 for a couple (approximately 312% of FPL in 2007).  Members pay a co-payment of $15 plus 50% of the remaining cost of each covered prescription.  Once members reach annual out-of-pocket expenses exceeding $2,000 for single persons or $3,000 for married couples, they pay only a flat $15 co-payment per prescription.
Disabilities coverage	Persons with disabilities under age 65 are eli