Summary State Pharmaceutical Assistance Programs

Research suggests that increasing drug prices affects some patients’ ability to adhere to their medication regimen. To help with the affordability of prescription drugs, lawmakers have considered state pharmaceutical assistance programs, known as SPAPs.  

State Pharmaceutical Assistance Programs

SPAPs are state-run programs that provide financial assistance to certain populations to help pay for prescriptions, though coverage varies widely by state, usage and specificity. Some SPAPs provide wraparound coverage for Medicare Part D, meaning they help cover the cost of prescriptions that Medicare Part D does not pay for. Some SPAPs, such as Maine’s Low Cost Drugs for the Elderly and Disabled Program, assist a wider range of individuals; others, including AIDS Drug Assistance Programs (ADAPs), a type of SPAP that pays for HIV/AIDS-related prescriptions, target specific populations.  

Historically, SPAPs were funded only by states. However, this changed when the 2006 Medicare Modernization Act officially recognized SPAPs, providing them with extra funding and support from the federal government. The Centers for Medicare & Medicaid Services outlined requirements states must meet to operate as “qualified SPAPs,” which receive additional federal benefits, including support from CMS in organizing Medicare Part D plan options.  

SPAP eligibility requirements vary by state and program. Some programs cover those who are unable to qualify for Medicare, while others may provide coverage for medications for certain diseases, like the ADAPs mentioned above. ADAPs receive some funding from the Health Resources and Services Administration as well. The effect of SPAPs is noticeable, with a recent study showing overall savings provided for program participants.  

State Discount Programs

Many states have established a subcategory of assistance programs known as a state discount program, sometimes termed “prescription buying clubs” or “discount cards.” Like SPAPs, state discount programs typically have eligibility requirements. However, these efforts differ from SPAPs because they do not rely on subsidized state or federal funds to pay for the pharmaceuticals. Instead, some state programs use their individual purchasing power to buy large quantities of various medications. The consumer then pays the resulting discounted price at the pharmacy counter. States implementing or maintaining discount programs will often use pharmacy benefit managers to handle price negotiations.  

Eligibility requirements vary from by state. Arizona’s CoppeRx is available to all residents, for example, while California’s Prescription Drug Discount Program for Medicare Recipients is only available to those eligible for Medicare. The federal 340B Program is similar in that participating manufacturers give discounts to certain types of health care facilities. However, states oversee program administration.