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

Updated: January 2, 2009

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.  By late -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			2008	restarted 6/08
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	2007
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 Semi Annual Delaware Prescription Assistance Program Report, January to June 2005

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 $6.00 generic and $7.00 brand co-payments. 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 eligible for state benefits, including coverage during the 2-year waiting period for federal Medicare eligibility.
Benefits	NJ will pay all premiums, deductibles and cost-sharing above the $6 or $7 per prescription copayment for PAAD enrollees. A person with $5,000 in annual Rx expenses might receive up to $3,600 in state-funded benefits
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.  Part D prescription "excluded drugs" are covered by PAAD and Senior Gold.
Est. # of beneficiaries	172,807 enrolled in PAAD as of 7/2007 26,237 enrolled in Senior Gold as of 7/2007
State laws	1975  NJ Ch.30: 4D-20 et seq. 2001 S.6; chapter 96 of 2001 2005: S 3000, (signed as Chapter 132, 7/2/05)
Special features & issues	The state PAAD benefit "shall only be available to cover the beneficiary cost share to in-network pharmacies and for deductible and coverage gap costs associated with enrollment in Medicare Part D for beneficiaries of the PAAD and Senior Gold programs, and for Medicare Part D premium costs for PAAD beneficiaries.
Other Rx programs	No other subsidies or discounts; New Jersey has a Prescription Drug Retail Price Registry to help consumers compare the retail prices charged by many pharmacies for the 150 most-frequently prescribed prescription drugs.
Contact & online information	Dept. of Health & Senior Services Telephone: 609 588-7048;  Toll-free in NJ: 800 792-9745 PAAD: http://www.state.nj.us/health/seniorbenefits/pbp/paad-home.shtml Senior Gold: http://www.state.nj.us/health/seniorbenefits/documents/seniorgold_factsheet.pdf

Updated: 10/23/2007, 7/9/2008.
Sources: NJ Department web site; text of S 3000, now Chapter 132 of 2005. 

NEW YORK	Elderly Pharmaceutical Insurance Coverage (EPIC)
New York’s EPIC plan, the nation’s largest state subsidy program, has enacted a wrap around plan that will pay for most drug costs not paid by Medicare, including deductibles, co-insurance or copayments, the gap in coverage above $2,250 and products not covered by Medicare.  Enrollees remain responsible for state-established copayments up to $20, fees or deductibles (up to $1,200).
Eligibility	Seniors age 65 or older with annual income up to $35,000 if single or $50,000 if married.  (Equal to approximately 336% and 357% of FPL in 2008.)  As of July 1, 2007 a new EPIC Law Requires Medicare Part D Enrollment.  There is a sliding scale annual fee from $8 to $300 annually for lower income enrollees; a deductible is required for individuals over $20,000 annual income.  Seniors who receive full Medicaid benefits are not eligible for EPIC benefits.
Disabilities coverage	Persons with disabilities under age 65 are not eligible for state benefits.
Benefits	Members of the EPIC Fee Plan receive free Medicare Part D coverage because EPIC will pay the monthly premiums (up to $24.45 a month, the average cost of a basic Medicare drug plan) for any Part D plan.  The EPIC Deductible plan is available to single seniors with income between $20,001 and $35,000, and married seniors with income between $26,001 and $50,000.   Those enrolled pay full price for their prescriptions until they meet an annual deductible which is also based on income.  An enrollee with annual income of 200% of FPL with $5,000 in Rx expenses might receive up to $2,900 in gap coverage and partial copayment assistance.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.  Part D prescription "excluded drugs" are covered by EPIC.
Est. # of beneficiaries	360,000 enrolled as of 6/2007;  of the total, 162,000 are enrolled in a Medicare Part D plan.  Of those 162,000, there are approx. 62,000 eligible for full Low Income Subsidy (LIS).
State laws	2005: S 3668 signed as Chapter 58 on 4/12/05.; 2006: A 9554; sections became law by veto override as Chapter 54, 4/26/06
Special features & issues	EPIC fee will be waived for those with Medicare Low Income Subsidy. EPIC can be combined with other plans to lower costs at the retail counter. For example, if a PDP requires a $25 copay for a $100 product, EPIC will cover the $25 expense and charge the enrollee only $7 as a copay. Co-branding agreements are being sought with all PDPs willing to meet criteria for seamless coordination with EPIC benefits.  The state is using “Intelligent Random Assignment” for all low income Subsidy members.  EPIC is considered “creditable drug coverage” at least equal to Part D, so state enrollees will not face a premium penalty if they do not enroll in Part D by May 2006.       The complex financial sliding scales of fees and deductibles in EPIC may present special challenges in calculating costs and benefits among private plans.    The legislature's FY 2006-07 budget, A 9554, authorizes continuing Medicaid wraparound coverage for duals until January 14, 2007.      Separate from EPIC, the NY Medicaid program, in limited circumstances "will provide an additional Medicaid 'wrap around' benefit for drugs not covered by the PDP in addition to the federally excludable drug categories. This will only occur after the prescriber has requested an exception (the first step in an appeal) with the PDP and has received a denial. To assure that the Medicare prescription benefit has been maximized prior to billing NYS Medicaid, the Medicare Verification System (MVS) was developed."  [View description online]
Other Rx programs	.
Contact & online information	EPIC Office Telephone: 518 452-6828; Toll-free in NY: 800 332-3742 Guide: Your Guide to New York State EPIC. [2008] http://www.health.state.ny.us/health_care/epic/index.htm

Sources: Presentation by Director Julie Naglieri 9/26/2005; NY EPIC web site; NY law text; interview with Scott Franko, EPIC Program 7/21/2006.  Updated: 3/6/2008.

NORTH CAROLINA	NC Rx       replaced Senior Rx
The North Carolina Senior Rx program closed on January 1, 2006, with all enrollees encouraged to join a Part D plan instead.  In November 2006, the state launched "NC Rx, " to be operational January 1, 2007.  The new program offers state subsidized help Part D premiums.
Eligibility	NC resident age 65 or over, enrolled in Medicare Part D plan.
Disabilities coverage	Persons with disabilities under age 65 are not eligible for state benefits.
Benefits	A senior may receive up to $18 a month or $216 annually toward premiums.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	enrollment opened mid-November, 2006
State laws	.
Special features & issues	New program starts January 1, 2007.  The program may require further legislative authorization and appropriations in 2007.
Other Rx programs	.
Contact & online information	For consumer assistance, call 1-888-488-6279 Web site: www.ncrx.gov

Updated 11/28/2006     Sources: NC website 11/27/2006.

OKLAHOMA	Rx for Oklahoma
Rx for Oklahoma is not a state subsidized benefit or "SPAP."  It is a clearinghouse that helps residents access prescription assistance programs provided by pharmaceutical manufacturing companies.
Other Rx programs	Oklahoma Prescription Drug Discount Program - See description below
Contact & online information	Toll-free: 1-877-RX4-OKLA Web site: http://www.health.state.ok.us/program/apep/RXDeveloper.html  |  RX for Oklahoma - Map

Updated: 12/18/2007        Sources:  Discussion with Dept. of Commerce staff, 12/17/2007

OREGON

Senior Prescription Drug Assistance Program - Never became operational - see archive list: see separate Discount Plan, below

Updated 11/30/2007

PENNSYLVANIA	1) Pharmaceutical Assistance Contract for the Elderly (PACE) 2) PACE Needs Enhancement Tier (PACENET) 3) PACE Plus Medicare
The Pennsylvania subsidy plan has operated since 1985 and will continue in 2006.  PACE Plus Medicare is a new program designed to convert the state’s drug assistance plans into a supplemental program that will “wrap around” private Medicare Part D prescription drug plans.   It gives the state the authority to act as a representative for its PACE and PACENET enrollees in matters relating to Medicare Part D, enrolling beneficiaries into Medicare Part D plans, pay Part D premiums, and apply for low-income subsidies on behalf of PACE and PACENET members.
State law(s)	1985 law 2006: SB 1188, signed as Act 111 on 7/7/06.
Eligibility	Residents age 65 or older.  PACE annual income up to $14,500 single; $17,700 married (Approximately 148% FPL in 2006.) PACENET catastrophic benefit option, annual income up to $23,500 single; 31,500 married (Approximately 240% FPL in 2006.)
Disabilities coverage	Persons with disabilities under age 65 are not eligible for these state benefits.
Benefit example	The Legislature made changes to law in order for PACE to pay premiums; as the wraparound portion of PACE and PACENET.  PACE members pay an average of 14% of total drug costs, which average $2,400 per person annually.  For the first nine months of 2006, PACE members pay a co-payment of $6 for generic and $9 for brand-name drugs.  PACENET members pay a co-payment of $8 for generic and $15 for brand-name drugs.   The new PACE Plus Medicare program will drop the $40 monthly deductible PACENET enrollees pay in favor of a monthly premium, not to exceed the regional benchmark Part D premium of $32.54. The premium will be treated like a deductible and will be collected by pharmacies. About 15,000 PACENET enrollees who do not normally use drugs may face higher costs under this new plan design.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.  Part D prescription "excluded drugs" are covered, only for Benzodiazepines, barbiturates, vitamins and weight loss.
Emergency gap coverage - 2006	Executive action allowed state Medicaid to pay the excess copay, the amount individuals are inappropriately charged over the low-income subsidy level. State expects to spend no more than $2 million during January and expects to be reimbursed by CMS and the plans for the costs. Governor's announcement, 1/12/06.  | Online: Pharmacy Cost Sharing Instructions (Interim)
Special features	The program allows members to be also enrolled in another prescription or heath plan. PACE is “creditable coverage,” meaning that enrollees who choose not to enroll in a Part D plan by May 15, 2005 will not face a premium penalty later.    PA law requires a manufacturer rebate for PACE purchases.  For 2006 the program is "intending to collect 'best price' rebates on any claim that PACE pays in full during the deductible period, coverage cap, or off formulary. On all other claims PACE will not be seeking a rebate." (4/4/06).  Enrollment in Part D is optional for new PACE Plus Medicare.  There will be six selected stand-alone Part D plans for the new auto-assign/auto-enroll process.  Auto-assignment began on 7/19/06 and auto-enrollment began on 8/8/06.  Enrollments were effective on 9/1/06.   In September 2005, Pennsylvania launched the Independent Drug Information Service in 28 counties, including Allegheny, Beaver and Lawrence, aiming to educate doctors about prescription drug benefits by helping them choose the most clinically appropriate medications for their patients.  The goal is to improve the prescription process by informing physicians on various drugs, rather than promoting a certain product. The concept was designed by Dr. Jerry Avorn, a professor of medicine at Harvard University.  In conjunction with the PACE program, eight specially trained drug information consultants began meeting with doctors at their practices last year. The consultants visit 25 to 30 doctors a month, mainly physicians whose prescribing habits don't mesh with their peers. The doctors are given evidence-based information on various types of drugs and brand-name alternatives are discussed.  As of April 2006 there have been 2,300 visits to physicians and about 420 educational sessions.  [news article 4/10/06] "Outreach medication education in Pennsylvania: A non-commercial source of evidence-based information about medication choices for physicians", Presentation by Michele Spetman, M.S., M.P.H.: May 19, 2006 (in PPT format)
Requirements & Limits	Medicaid enrollees and public Retired Employees Health Plan (REHP) enrollees are not allowed to enroll in PACE or PACENET.
SPAP legal status	Qualified SPAP approved by CMS; payments count toward enrollee TrOOP, 7/2007
Est. # of beneficiaries	311,000 total 184,049 in PACE  as of 7/2007 (an estimated 80,000 eligible for extra help in 2006) 127,881 in PACENET as of 7/2007.
Funding source	PA State Lottery and tobacco settlement funds; also a small part covered by general funds.
future issues	State law on PACE was changed in July 2006 by the legislature's SB 1188 of 2006 (Act 111 of '06).  The state discussed choosing to have an “unqualified SPAP” by selecting a preferred plan or plans.  State will base premium assistance from average of standard PA plans. It was anticipated that, because of the new PACE Plus Medicare program, the PACE and PACENET programs will be expanded by 35 percent to cover an additional 120,000 enrollees by 2007.
Contact & information Web site	PA Dept. of Aging 555 Walnut Street, 5th Floor, Harrisburg, PA  17101 Residents toll-free 1-800-225-7223 or (717) 787-7313; FAX: 717-772-2730 http://www.aging.state.pa.us/aging/cwp/view.asp?a=554&Q=254019&agingNav=|6658 | http://www.aging.state.pa.us/aging/cwp/view.asp?a=293&q=252808 http://pda-apprise.org/providers/  Email: aging@state.pa.us Independent Drug Information Service, at http://rxfacts.org/home.html News article:  New drug program to start for Pa. seniors - Philadelphia Inquirer, 9/1/06

Updated: 6/2007, 2/2008
Sources: Director Tom Snedden presentation and statements 8/18/05; 4/4/06; 5/8/06; PACE web site, 11/27/05; Theresa Brown, PA Dept of Aging, 12/2005; NCSL State Health Notes article, 7/24/2006. 

RHODE ISLAND	RIPAE - Rhode Island Pharmaceutical Assistance for the Elderly
The currently operational RIPAE subsidy program continues in 2006-07.  The details of wrap around and coordination of benefits were not available as of the publication date of this report.
Eligibility	Minimum age is 65, or between 55 and 64 if disabled and receiving Social Security Disability Income (SSDI) payments.  There are three levels of coverage, based on income: 15% discount if over 65 or age 55-64 and disabled with income of $23,506-$41,136 (individual) and $29,384-$47,012 (couple); 30% discount for over 65 with income $18,725-$23,505 (individual) and $23,408-$29,383 (couple); and 60% discount for over 65 with income up to $18,724 (individual) and up to $23,407 (couple) (392.6% of FPL for 2006).
Disabilities coverage	Disabled individuals under age 55 are not eligible for state benefits.
Benefits	The details of Part D wrap around and coordination of benefits were not available as of the publication date of this report.  The RIPAE program pays "a portion of the cost of prescriptions used to treat Alzheimer’s disease, arthritis, diabetes (including insulin and syringes for insulin injections), heart problems, depression, anti-infectives, Parkinson’s disease, high blood pressure, cancer, urinary incontinence, circulatory insufficiency, high cholesterol, asthma and chronic respiratory conditions, osteoporosis, glaucoma, and prescription vitamins and mineral supplements for renal patients for eligible Rhode Island residents 65 and older." RIPAE enrollees can purchase all other FDA-approved "Category B" prescriptions (except for those used to treat cosmetic conditions) at the RIPAE-discounted price.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	17,870 enrollees as of 7/2007
State laws	1985, 2003: RI General Laws §42-66.2-5
Special features & issues	Excludes income spent on medical expenses if greater than 3% of total income.   Residents between 55 and 64 who are receiving SSDI payments can purchase medications at a 15% discount.  There is no state co-payment for these medications.  Income limits for SSDI recipients are $41,136 for individuals and $47,012 for a married couple.   The details of wrap around and coordination of benefits may require legislative and executive branch action and approval in 2006.  Income limits were increased by 4.1% in 2006 to reflect the annual Cost-of-Living Adjustment (COLA) as determined by the Social Security Administration.  Injectable prescription medications used to treat Multiple Sclerosis were added to the list of medications covered under the main category of drugs paid for under RIPAE.  These changes took effect on 7/1/06.
Other Rx programs	Yes, RI Prescription Drug Discount for the Uninsured, see below
Contact & online information	Dept. of Elderly Affairs (401) 222-2880 http://adrc.ohhs.ri.gov/paying/Prescription_Assist.php

Updated: 12/20/2005 & 8/1/2006
Sources:  RIPAE website; RI Legislative website 12/05; Information sheet from RIPAE Director's Office 8/1/2006. 

SOUTH CAROLINA	GAPS - Gap Assistance Prescription Program for Seniors
GAPS provides wrap around coverage for the Medicare gap of $2,400 - $5,451.25 /year annually.
Eligibility	Minimum age: 65, with annual income up to 200% FPL ($20,420 for individual). Must be enrolled in Medicare Part D plan, must select one of 17 specified PDPs that are participating in GAPS (2007).
Disabilities coverage	No; only over age 65 and on Medicare.
Benefits	GAPS provides supplemental wrap around coverage for the Medicare gap of $2,400 - $5,451.25 /year annually (2007 figures) Medicare-Medicaid dual-eligible enrollees with incomes under 150% FPL who are eligible for low-income "extra help" usually will not need GAPS benefits.  GAPS uses a Preferred Drug List, 2007.
Medicare wrap around	Yes; provides wraparound coverage for the Medicare gap of $2250-$5100 annually
Est. # of beneficiaries	12,000 as of 7/2007.
State laws	2005: HB 3716 - Sec. 8-J02  Signed into law 6/26/05.  Operational 1/1/06. 100% state funded.
Special features & issues	The former state subsidy program SILVERxCARD ended on December 31, 2005, and was replaced with the new GAPS plan. The program, as well as Medicaid Rx, is administered by First Health Services, part of Coventry Health.
Other Rx programs	No
Contact & online information	Department of Health and Human Services  |  Rx program description Tel: Toll-Free: 1-888-549-0820; (803) 898-2865;  Office of Insurance Services (803) 734-1061 http://southcarolina.fhsc.com/Beneficiaries/gaps/documents.asp GAPS Medicare PDP Letter

Sources: GAPS web site accessed 4/12/2007; NCSL summary of SC law                                     Updated: 4/12/2007

TENNESSEE	Cover Rx (subsidy)
CoverRx is a statewide pharmaceutical assistance program for adults ages 19-64 lacking pharmacy coverage, providing a sliding scale subsidy for generics for residents with incomes up to 250 percent of federal poverty.  Selected brand name products may be available at a discount, without state subsidy.
Eligibility and charges	State residents, ages 19-64 with household income up to 250% FPL. Must be U.S. citizen or qualified legal alien, residing in the state at least six months.  Must not have prescription drug coverage, including Medicare, TennCare/Medicaid or employer sponsored drug coverage.  There is no enrollment fee or premium; copayments are required for each purchase. Operational as of 1/2/2007. "Due to high demand," CoverRx enrollment was temporarily suspended in April, but reopened for 3,500 on a waiting list and new applicants.
Disabilities coverage	No, only if ages 19-64 and otherwise qualified.
Benefits	Approximately 250 generic drugs are available, with a three-tier copayment based on income. For a 90-day supply - Below 100% FPL is $3; up to 149% FPL is $12; 150% to 250% FPL is $20. All other drugs (including available brand names) are available at a flat discount, defined as "lesser of Discount, 'Maximum Allowable Cost' or 'usual and customary' price; no prior authorization program for drugs off formulary .  Online [Price chart online] [Rx product list; formulary]
Medicare wrap around	No, Medicare Part D eligibles and enrollees are disqualified.
Est. # of beneficiaries	21,000 (4/30/07)
State laws	2006: Signed 6/12/06
Special features & issues	Cover Rx combines features of a discount-only program with features of a subsidy (SPAP) program.  It is part of a 5-part health program called "Cover Tennessee." The formulary list is administered by ExpressScripts.
Other Rx programs	Yes. Cover Rx -Discounts, see below
Contact & online information	Cover Tennessee, Dept. of Finance and Administration Toll-Free 1-866-COVERTN Public Information Officer:  (615) 532-1921.  Online: http://covertn.gov/cover_rx.html

Sources: CoverTN web site, accessed 4/12/07; NCSL summary of law                                     Updated: 9/13/2007

TEXAS	Kidney Health Care Program Mental Health Medication Program
The Kidney Health Care Program is limited to individuals diagnosed with end-stage renal disease; the Mental Health Medication Program also is limited to those treatment products;  The programs are listed primarily because they are recognized by CMS as "qualified SPAPs."
Eligibility	State residency and ESRD must be certified; applicant must be receiving a regular course of chronic renal dialysis treatments or have received a kidney transplant; an application for benefits must be submitted through a Medicare approved hospital, VA facility, or KHC approved facility; an application for ESRD benefits must be filed with Medicare; and KHC-established financial criteria must be met.
Benefits	The Kidney Health Care Program (KHC) provides assistance to residents with a diagnosis of End-Stage Renal Disease (ESRD) that have met program eligibility requirements.  The KHC program services include: prescription drug benefits, coordination of benefits and premium reimbursements for Medicare Part D Prescription Drug Program, co-insurance for immunosuppressive drugs covered under Medicare Part B, limited travel reimbursement and certain medical expenses.   KHC will pay for up to four (4) prescriptions per month for Part B and D coverage. The drug must be on the KHC drug list and the Medicare Part D plan’s drug list.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	18,877 as of 7/2007.
Special features & issues	Beginning on January 1, 2008, KHC will not reimburse enrollees directly for premium payments. The Part D plans will bill KHC for enrollee premiums.  See Regulations: 25 TAC §§61.1 – 61.14 of 2005.
Contact & online information	Kidney Health Care Program, Texas Department of State Health Services P.O. Box 149347, Austin, Texas 78714-9347 Toll-free: 1-800-222-3986;Local: 512-458-7150, ext. 6879; Fax: 512-458-7162. http://www.dshs.state.tx.us/kidney/ 2008 requirements: http://www.dshs.state.tx.us/kidney/pdf/2008_KHC-MCRD_Eng.pdf Mental Health: 1100 W 49th, Austin, TX 78756; tel. 512-458-7135

Sources: NCSL summary of program; Kidney program website.                                     Updated: 2/22/2008

VERMONT	VPharm VHAP-Pharmacy VScript
VPharm is a recent program that is a hybrid of the previously operating Vermont Rx assistance programs, which first started in 1989.  The wrap around features allow the state to pay enrollee out-of-pocket costs; it started January 1, 2006.
Eligibility	Residents on Medicare or SSDI with annual income up to 225% FPL. ($22,050 in 2006.)  For those between 150% and 225% FPL, only maintenance drugs in those classes are covered.  For those on Medicaid and those below 150% FPL, both maintenance and acute drugs are covered.  VPharm also covers most cost-sharing that is not paid by the federal Medicare Part D low-income subsidy.
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.  Must be eligible for Medicare Part A or enrolled in Medicare Part B.
Benefits	VPharm assists Vermonters who are enrolled in Medicare Part D with paying for prescription medicines. This includes people age 65 and older as well as people of all ages with disabilities.  For Medicare-Medicaid dual eligibles, it covers all non-part D drugs.  For pharmaceuticals-only benefit, will cover all costs of premium, copay, coinsurance and doughnut hole.  Those above the dual eligible income cutoff pay on a sliding scale: 150-175% FPL pay $17 VPharm premium; 175-200% FPL pay $23 premium; 200-225% FPL pay $50 premium.  VPharm pays all other costs.    VHAP-Pharmacy helps Vermonters age 65 and older and people with disabilities who are not enrolled in Medicare pay for eye exams and prescription medicines for short-term and long-term medical problems and includes an affordable monthly premium. VScript helps Vermonters age 65 and older and people of all ages with disabilities who are not enrolled in Medicare pay for prescription medicines for long-term medical problems. There is also an affordable monthly premium based on your income.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	Total = 30,000 (Rx + duals)   14,285 enrolled in VPharm as of 7/2007.
State laws	2005: H 516
Special features & issues	Programs operate within Green Mountain Care, which "is a family of low-cost and free health coverage programs for uninsured Vermonters." VPharm Program started January 1, 2006.  Received CMS approval to do auto assignment of duals into a few commercial Part D plans.  Covers all costs (other than VPharm premium) for Rx only benefit side.  The state has additional pharmaceutical assistance programs for non-Medicare populations. VHAP-Pharmacy, VScript and VScript expanded will continue only for those who are 65 and older or who receive disability benefits from Social Security, but who are not eligible for Medicare.  VPharm was created as a wraparound for Part D. [Source: "State Part D Wrap Around for SPAP Beneficiaries," Report by the Centers for Medicare and Medicaid Services, April 5, 2006.]
Other Rx programs	Yes. Healthy Vermonters, see below
Contact & online information	Dir. of Health Program Integration Unit (VHAccess) Telephone:800 529-4060 (in state);  800 250-8427 (out of state) http://www.greenmountaincare.org/about/green_mountain_care_programs.html#prescription http://www.dad.state.vt.us/MedicarePartD/Flyers.pdf | http://www.dad.state.vt.us/MedicarePartD/Default.htm

   Sources: VT Legislative website; text of H 516; Interview with program & legislative staff,  2/08; 11/20/08                Updated: 12/19/05; 11/20/08

VIRGINIA	Virginia Department of Health SPAP
The Virginia SPAP pays Medicare Part D costs for people diagnosed with HIV/AIDS who get medicines through the Virginia AIDS Drug Assistance Program (ADAP).
Eligibility	Must be Medicare eligible, diagnosed with HIV/AIDS and enrolled in both ADAP and a Medicare Part D plan.  Household income between 135% and 300% Federal Poverty Level ($13,784 and $30,630 for a single person; up to $42,000 for a 2-person household in 2007.)
Disabilities coverage	No, unless diagnosed with HIV/AIDS and enrolled in both ADAP and a Medicare Part D plan.
Benefits	As of 1/07 the SPAP will help pay for monthly Part D premiums, and "will soon pay all medication copays/coinsurance, deductibles and medication costs during gaps in coverage."
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	100 enrollees as of 7/2007.
State laws	.
Special features & issues	Current enrollees will be notified when the program will start paying for copays/coinsurance, deductibles and gaps in coverage. "When SPAP starts covering copays, you will be able to use your Medicare Part D plan to get all your medicines (including medicines you currently receive from ADAP). Participants can use a retail or mail order pharmacy to fill all medicines covered by a Part D plan." Patient Services Incorporated (PSI) manages the SPAP under a contract with the Virginia Department of Health effective 2008.
Other Rx programs	no.
Contact & online information	Virginia SPAP P.O Box 2448, Richmond, VA 23218; Hotline: (800) 533-4148 FAX: (804) 864-8050 Web: http://www.vdh.state.va.us/Epidemiology/DiseasePrevention/spap.htm [2/08] Fact sheet :  http://www.vdh.state.va.us/Epidemiology/DiseasePrevention/documents/SPAP%20Fact%20Sheet%20June%202007%20Update.pdf  [2/08]

Sources: state web site                                     Updated: 2/2008

WASHINGTON	Medicare Copayment plan
In February 2006, Gov. Gregoire announced a new plan to use $14 million already appropriated for the "clawback" but no longer owed to HHS due a recalculation of the state's total for FY 2006.  The funds will be used as a state payment of the $1 to $5 copayments owed by dual-eligibles.
Eligibility	Medicaid dual-eligibles under 150% of federal poverty.
Disabilities coverage	.
Benefits	The Department of Social and Health Services went live on February 21, setting up pharmacy codes so that pharmacists can now bill the state directly for the co-pays.  State will pay for copayments ($1 to $5 per prescription, per month) charged by Part D PDP plans.  Funded through June 30, 2007.
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	Through 6/06, $1.722 million spent on 873,127 claims.  The Average cost/claim is $1.97.  The number of claims/person dropped from 5.68 in 2/06 to 2.96 in 6/06.  From February through June 2006, the program has not spent as much as had been anticipated.
State laws	2006 supplemental budget language passed by legislature in March as SB 6386 and signed by the Governor on March 31 reappropriates $14 million in  savings, for the purpose of covering co-pays through the end of June, 2007 (the end of WA 2005-2007 biennial budget period).
Special features & issues	Other programs:  In 2003 the Legislature passed the Washington State Prescription Drug Program, known as Rx Washington. Rx Washington was established to develop an evidence-based prescription drug program to identify preferred drugs; make prescription drugs more affordable to Washington residents and state health care programs; and, increase public awareness regarding the safe and cost-effective use of prescription drugs.  The Rx Washington Card provides savings of 15-25% on prescription drugs. This card provides discounts at mail order and retail pharmacies within the Express Scripts national network of pharmacies. The annual membership fee is $10 per person.  Washington residents who purchase prescription drugs not covered by their insurance program are eligible for the Rx Washington Card. There are no other eligibility requirements. The Rx Washington Card is not a Medicare Part D prescription drug plan. However, the Rx Washington Card may provide discounts on medications that are not covered by Medicare or other insurance you may have.
Other Rx programs	Yes. Washington Prescription Drug Discount Card (WPDP), see below
Contact & online information	http://fortress.wa.gov/dshs/maa/Medicaredrugs/

Updated: 2/10/06, 3/26/06 & 7/31/06
Source: Governor Chris Gregoire's statement, 2/4/06; Telephone interview with Carol McCree, Div. of Customer Support, 7/31/06.

WISCONSIN	WisconsinCare (effective January 1, 2008)  Formerly called SeniorCare Rx (until December 31, 2007)
A senior subsidy program serving residents up to 240% of federal poverty.  Includes a voluntary Medicare Part D wrap around benefit was negotiated but not agreed to in 2006.  SeniorCare Rx  does not offer any "donut-hole" coverage for those up to about 240% FPL, but does have sliding scale cost-sharing as income rises.  The WI federal "Pharmacy Plus" Medicaid waiver,  was extended to December 31, 2009.  For 2007 only this allowed federal matching funds for services covered by Medicare Part D in the other 49 states.  (update 12/31/07)
Eligibility	Resident age 65 or older up to (level 1, 160% FPL), (level 2a, 200% FPL),  (level 2b, 240% FPL) receive subsidy.  If over $24,961 per individual (level 3),  the enrollee must "spend down" below that amount.  There is no asset limit.  A $30 annual enrollment fee per person is required.  Program participants are subject to certain annual out-of-pocket expense requirements depending on their annual income.   (Income levels based on the 2005 federal poverty guidelines, still in effect 1/26/06). NOTE: Everyone currently in SeniorCare, whose income is less than $24,504 ($32,856 for a married couple), will be signed up for WisconsinCare automatically.
Disabilities coverage	Excludes the disabled, whether or not eligible for  Medicare.
Benefits	An individual whose gross annual income is greater than 160% of the current FPL and less than or equal to 200% of the current FPL will have an annual deductible of $500, meaning participant(s) pay for the first $500 of covered prescription drug costs at participating pharmacies each year.   After the $500 deductible is met, covered prescription drugs can be purchased at the co-payment amounts for the remainder of the annual benefit period. The co-payments are $5 for each covered generic prescription drug, and $15 for each covered brand name prescription drug.
Medicare wrap around	Yes, but only for enrollees above 200% of FPL; these state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	111,267 enrolled, as of 7/16/06 (includes 79,523 waiver and 31,744 non-waiver enrollees)
State laws	Wis. Admin. Code (HFS 109); SB 55 (2001) (Sec. 1823, 49.477);  WI Stat. § 49.688 (2004); The program has an approved Medicaid 1115 "Pharmacy Plus" waiver, still in effect for 2006 and 2007.
Special features & issues	Individuals with prescription drug coverage under other health plans are eligible to enroll in SeniorCare.  If an enrollee already has a health insurance plan, SeniorCare will coordinate benefit coverage with that plan.  The Department of Health and Family Services has determined that the prescription drug coverage offered by SeniorCare is "creditable coverage." This means that SeniorCare coverage, on average, is as good as the standard Medicare drug coverage.      "Non-risk based lump sum approach.  Those in spend down are not eligible for the wraparound benefit; will not cover drugs not already covered by Part D or drugs not included in PDP formulary." [Source: "State Part D Wrap Around for SPAP Beneficiaries," Report by the Centers for Medicare and Medicaid Services, April 5, 2006.]
Other Rx programs	Badger Rx gold provides a retail counter discount for any resident that lacks prescription drug insurance coverage if the person enrolls and pays the annual enrollment fee.
Contact & online information	SeniorCare Customer Service Hotline:  (800) 657-2038 http://dhfs.wisconsin.gov/seniorcare/

Sources:  SeniorCare website; e-mail correspondence with WI DHFS; SB 55 (2001); WI Admin. Code.            Updated: 6/6/2008

WYOMING	Prescription Assistance Program
Wyoming's pharmaceutical coverage of Medicare Part D eligibles was discontinued May 31, 2006.  State-only coverage continues for those under 100% FPL not qualified for Medicare.
Eligibility	Any resident with annual income up to 100% FPL with no other Rx coverage (includes Medicare Part D).  Also has a vehicle value limit of $15,000 and cash asset maximum limit of $2,500.  No age restriction.  Medicare Part D enrollees will be disqualified as of June 1, 2006.
Disabilities coverage	The state will continue to include persons with disabilities with the same income and asset requirement as others.
Benefits	The state program will cover up to three prescriptions per month, requiring enrollee copay of $25 brand, or $10 generic products. Uses state Medicaid prefered drug list: http://uwacadweb.uwyo.edu/PDL
Medicare wrap around	Yes; all state benefits are provided in coordination with federal Medicare.  Qualified SPAP; payments count toward TrOOP.
Est. # of beneficiaries	269 enrollees, as of 8/1/06.  The number of enrollees will likely increase; no good estimate at this time, since the program just reopened on 7/1/06.
State laws	Wyo. Stat §42-4-118
Special features & issues	Also covers prescribed oxygen. Agency officials are "waiting to see what legislature will do with the program, since it currently has a capped enrollment." As of 7/1/06, the program reopened to new enrollment for people earning less than the federal poverty level.  The program is not limited to only seniors or the disabled.
Other Rx programs	.
Contact & online information	Prescription Assistance Program Pharmacist Consultant - Telephone 307-777-8699. http://wdh.state.wy.us/pharmacy/pdap.asp

Updated: 12/19/05 & 7/31/06
Source:  WY Pharmacist Consultant 307-777-8699 alewis@state.wy.us

State Discount Programs - TABLE 2

In almost half the states, programs created in the past six years provide for a reduced or discounted retail price for eligible participants, but do not provide a state subsidy for the purchase of prescription drugs. In several states, discount programs have been added to or integrated with subsidy programs - see related details in chart one above. In several other states, such as Arkansas, Colorado, Connecticut, Massachusetts and Oklahoma, enacted program features have not yet been established or implemented.  

Other cost-related programs and proposals, including multi-state projects, inter-agency purchasing, coordination of industry charity programs, evaluating pharmaceutical advertising, and regulating commercial discount cards, are listed separately - see NCSL Pharmaceutical Reports menu page. 

ARIZONA	CoppeRx Card
The CoppeRx Card program was launched in 2003 as a discount plan aimed at seniors and disabled; in 2005 eligibility was expanded to include all residents.
Eligibility	All Arizona state residents are eligible. There is no enrollment fee for CoppeRX.
Disabilities coverage	Yes, any state resident is included in the discount program.
Benefits	After expanding the program, participating pharmacies will offer discounted prices negotiated by the state with manufacturers and pharmacies for those who present the card upon picking up any prescriptions.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	1,000,057 Arizona residents are enrolled in the program. Approximately 59,000 people use the card each month.
State laws	Governor Janet Napolitano announced the program in January 2004 http://www.rxamerica.com/media/pdf/az_press_copperx.pdf (hyperlink to news release from Governor office).
Special features & issues	Hundreds of Arizona pharmacies present the card upon picking up any prescription drug medications. It is intended to serve those without prescription drug coverage and to fill gaps that Medicare Prescription plans have.
Other Rx programs	Yes. Medicare Co-Payment Plan
Contact & online information	Program administered by AHCCCS: Tel: 602-417-4000; Tel. for CoppeRx Card Holders: 1-888-227-8315 http://www.rxamerica.com/az_discount_home.html

Sources: AZ website; interview with Governor Health Policy Advisor                                  Updated: 7/2007

ARKANSAS	Arkansas Rx Program  NOT OPERATIONAL  -did not implement because there was not enough participation ---See ARCHIVE
Arkansas Rx was enacted in law as a statewide discount program for uninsured residents either over 65, disabled or under age 65 with annual income up to 350% of federal poverty.  The program opened enrollment in 2006, but it is not operational for benefits and was never implemented.
Eligibility	State residents age 65 years and older.  Family income must be below or equal to $2790.00 per month for one person, $3740 for two people, $4690 for three people, $5640 for four people. Not enrolled in another drug plan or insurance plan that offers discounts on prescriptions. Enrollment fee set at $25.
Disabilities coverage	Yes, any state resident is included in the program.
Benefits
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	None
State laws	2005: HB 1241; Act 538, Signed 3/3/05
Special features & issues
Other Rx programs
Contact & online information	Tel: 1-866-695-6508 (in-state)  Arkansas RX Program, P.O. Box 8036, Little Rock, AR 72203-9863 Web: https://www.rx.arkansas.gov/  Representative Dustin McDaniel, lead legislative sponsor.

Sources: Interview with Director of Human Services                                                            Updated: 7/2007

CALIFORNIA	1) California Prescription Drug Discount Program for Medicare Recipients (2000-) 2) California Discount Prescription Drug Program (2006-)
Created by a 2006 law, the California Discount Prescription Drug Program will reduce prices on generic drug purchases for residents under 300% of the federal poverty level who lack Rx coverage.
Eligibility	Any resident without prescription drug coverage with income under 300% of the federal poverty level ($21,200 for an individual; $63,600 for a family of four in 2008), seniors, and those up to $68,000 for family of four with high health costs; enrollees are to be sent a program discount card for "a nominal" $10 annual fee.  NOT YET OPERATIONAL California Prescription Drug Discount Program for Medicare Recipients includes anyone who is eligible for Medicare, seniors over the age of 65 and those under the age of 65 who are disabled. The fee is 15 cents per prescription filled.
Disabilities coverage	Yes, for disabled that otherwise qualify
Benefits	2006 program: Provide access to up to 40 percent savings on brand name and up to 60 percent savings on generic prescription drugs. Medicare: Prescription drugs are at the Medi-Cal prescription rates with over 500 pharmacies throughout California. No prior authorization is needed on prescription drugs and virtually all prescriptions are covered.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	not operational; an estimated 5,000,000 resident could be eligible. "SB393 Program" reported 850,000 *price inquiries /month. Program has no enrollment process. (est. 1.3 million eligible)
State laws	2006: AB 2911, signed 9/29/06; Statute: Health and Safety Code Section 130542 Medicare enrollee programs: 1999 law SB 393; 2001 law SB 696
Special features & issues	The program was contentious during the legislative and ballot question phase - see news article on signing 9/29/06.  Funding eliminated August 21, 2007: $6.3 million from the California Discount Prescription Drug Program Fund: The Governor zeroed out the money to implement this program that would negotiate with drug companies to provide discounts to uninsured and underinsured Californians. In his veto statement, he directed the Department to identify ways to start the work, but the program is likely to be delayed. The pricing structure includes these features: "Consider three different benchmarks in negotiations with drug manufacturers: the Medicaid Best Price, the lowest price offered to private payers, and the average manufacturers’ price minus 15 percent.   For the first three years, gives drug manufacturers the ability to voluntarily negotiate discounts. If after August 1, 2010, manufacturers do not provide discounts at the benchmark levels, the state may, upon federal approval, tie participation in Medi-Cal with participation in this program as long as imposing this linkage does not disrupt care of California’s Medi-Cal enrollees and budget neutrality is maintained." Program fund description: http://www.dof.ca.gov/html/calstars/funds/8040.doc
Other Rx programs	1) Genetically Handicapped Persons Program is a single-condition limited eligibility program certified as a "qualified SPAP" by CMS. 2) California Discount Prescription Medication Program (1999-2006)  California was one of the first to launch a statewide prescription drug discount program, aimed at the Medicare population.  With no income or enrollment requirements, residents just show a Medicare Card to be eligible for a calculated price reduction at the counter, based on the state Medi-Cal (Medicaid) negotiated price.  The need for this program reduces substantially once individuals enroll in the federal Medicare Part D drug plans, but those not using Part D or facing a gap in coverage may use this plan.
Contact & online information	Tel: Dept. of Health Services: 916-657-4302 or 916-552-9714 and HICAP: 800-434-0222            Fact sheet: http://gov.ca.gov/index.php?/fact-sheet/4310/  (2007) Medicare program:  http://www.dhs.ca.gov/mcs/mcpd/MBB/contracting/sb393/ News release: Governor Schwarzenegger Signs Legislation to Make Prescription Drugs More Affordable, at http://gov.ca.gov/index.php?/press-release/4159/

Sources: CA websites; conversation with agency 10/07.                                   Updated: 2/2007, 1/22/2008, 2/22/2008

COLORADO	Colorado Cares Rx
Colorado Cares Rx program was created in 2007 to provide generic and non-patented prescription drugs to eligible uninsured and underinsured residents, with annual income up to 300 percent of federal poverty guidelines; it launched in February 2008.
Eligibility, fees	State residents of all ages; must not have health insurance and not be eligible for Medicaid or SCHIP, with maximum annual income up to 300% FPL (Set at $31,200 individual; $42,000 for couple in 2008).
Disabilities coverage	Yes, if otherwise qualified.
Benefits	As of February 2008: Over 125 generic prescription medicines are available, from Rx Outreach, a mail order patient assistance program. Discounted prices are set at: $20, $30 or $40 for a 90-day supply; prices may be negotiated by the state with manufacturers and the contracted mail-order form. Enrollment began on 12/12/2007 and the program started providing benefits on 2/1/2008.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	None enrolled.  Est. 397,000 may be eligible.
State law	2007: SB 07-001, signed 2/1/2007.  (CRS §25.5-2.5) Sen. Hagadorn, lead sponsor
Special features & issues	The law specifies that 1) the Department may expand eligibility to persons covered by high deductible health plans, which exclude insurance payment for the first $1100 (or more) of spending by an individual.  2) Retail pharmacies enter into voluntary agreements to participate; the price to enrollees must be not less than Average Manufacturer Price (AMP) or actual cost and not more than WAC plus dispensing fee or the "customary charge" for the drug.  3) Other (brand name) manufacturers may participate in negotiations for participation in the program.  4) $2.2 million is appropriated for implementation beginning July 1, 2007.  5) A registration fee of not more than $20 is authorized but the 2008 fee has been eliminated. 6) The legislation authorized participating pharmacies; in 2008 the program is run by a single mail-order firm. News article: "Rx program has room to improve" 3/3/08.
Other Rx programs	The "Prescription Drug Information and Technical Assistance Program" provides Medicaid patients with advice from pharmacists, effective January 2008.
Contact & online information	Department of Health Care Finance and Policy -552-9500 CO Care Rx Fact sheet: http://www.chcpf.state.co.us/HCPF/Web/ColoradoCaresRx0108.pdf Applications can be downloaded from www.ColoradoCaresRx.com

Source:  SB 07-001; Interviews with Pharmacy Program at the Department of Health                           Updated: 8/2007; 2/19/2008

CONNECTICUT

ConnPACE part "B"- Never operational, See Archives

DISTRICT OF COLUMBIA	AccessRx program
The District is authorized to negotiate lower prescription drug prices for uninsured residents with household incomes up to 350% of federal poverty.  Enacted in 2004, it is not operational.
Eligibility	Uninsured residents (no age restrictions) with a household income not more than 350 percent of the federal poverty level—$35,735 for individual; $47,915 for couple. Low-income seniors with annual income up to 200 percent of the federal poverty level — $20,420 for individuals and $27,380 for couples (2007 rate).  Program is not operational.
Disabilities coverage	Yes, if income eligible as above.
Benefits	Access Rx will provide a discount on prescription drugs; the actual value of the benefits are not yet determined.
Est. # of beneficiaries	None enrolled.
State laws	Bill 15-569  signed 3/25/2004
Special features & issues	The law authorizes the director of the Department of Health to negotiate rebate agreements with drug manufacturers and labelers that sell prescription drugs through publicly funded pharmaceutical assistance programs in the District.  Rebates are to be placed in an AccessRx Fund and used to reimburse pharmacies for drug discounts. Manufacturers and labelers who do not participate in this program will have their names publicized as a partial incentive to participate. The program will be funded through a variety of cost containment measures including manufacturer rebates, pharmacy discounts and aggregate purchasing for other government pharmaceutical assistance programs.
Other Rx programs	DC also offers all residents "Prescription Ordering Using Minnesota's RxConnect Website"
Contact & online information	The AccessRx program

Sources: DC Council web site 2/2007; NCSL summary of DC law.                                              Updated: 5/2007

FLORIDA	Florida Discount Drug Card
The Florida Discount Drug Card is designed to lower the cost of prescriptions for Florida residents without drug insurance coverage.  Enrollees save an estimated 5 to 40 percent on Rx purchases.
Eligibility	Florida residents who have no drug insurance coverage and are either 1) age 60 and older, or 2) under age 60 with a total family income under 300 percent of the Federal Poverty Level. Qualifying incomes are $2,553 per month for an individual, $3,423 for a family of two, and $5,163 for a family of four. (as of 12/2007)
Disabilities coverage	Yes, all who qualify under income and age requirements above.
Benefits	"Savings will vary depending on the quantity, type and brand of the drug purchased.  Average savings on 10 commonly used prescription drugs ranged from 5 to 42 percent; "virtually all prescription drugs" may be available. Click here to check Drug Pricing.  Member card may Be used at all participating pharmacies: Pharmacy Locator
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	n/a
State laws	Created by executive agency action, December 2007.
Special features & issues
Other Rx programs	No.  In 2000 Florida enacted a subsidy program and another discount plan, named Senior Prescription Affordability Act - they were phased out in 2005 and are not operational -- see ARCHIVE
Contact & online information	Information on Florida Discount Drug Card, call Toll-free: 1-866-341-8894 (TTY Users may call 1-866-763-9630) or e-mail flddcp@envisionrx.com Web: http://www.floridadiscountdrugcard.com

Sources: Gov. Christ news release; agency web site, 12/27/07; 1/22/08                                                                          Updated: 12/27/2007

HAWAII	Hawaii Rx+ Discount Program
Hawaii Rx+ was launched in 2005 as a statewide discount program aimed at assisting any uninsured or underinsured resident, regardless of age, with income up to 350% of federal poverty.  It has features in common with the Maine Rx+ program.
Eligibility	All Hawaii residents who are uninsured or underinsured with income levels below 350% of 2004 federal poverty level. There are no age restrictions. Membership is free.
Disabilities coverage	Yes, all Hawaii residents, including those who are on Medicare may be eligible.
Benefits	Pharmacist should offer best price on prescriptions when the discount card is presented, rebates are only given on brand name prescriptions and not generic brands. Seniors can take advantage of both the Rx plus card and the Medicare Part D benefits. 143 out of 186 pharmacies participate in the discount program
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	149,460 people enrolled as of July 28, 2006.
State laws	2002 HB 2834, Act took effect on July 1, 2002; 2004 HB2005
Special features & issues	.
Other Rx programs	.
Contact & online information	operational 7/1/04 Department of Human Services 808-586-5036(in-state residents only)  See related article (8/2/06)

Sources:NCSL summary of law                                                                             Updated: 2/2007

ILLINOIS	IL Rx Buying Club
The Rx Buying Club began as a Governor's initiative in 2003 for seniors and disabled.  As of  2006 it was expanded by the legislature to allow residents of any age, with incomes up to 300% of federal poverty guidelines, to buy prescriptions at a discount.
Eligibility	Any in-state resident who has a household income equal to or les than 300% of 2007 federal poverty level. A single person household annual income must be equal to or less than $30,630. Annual administrative enrollment fee is $10.00 and non-refundable.
Disabilities coverage	Yes, if otherwise qualified.
Benefits	Senior citizens and person with disabilities can receive discounts on all FDA approved prescription drugs.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	64,718 as of January 10, 2005
State laws	2003 law: SB 3; 2005: HB 973
Special features & issues	.
Other Rx programs	Also offers Illinois Cares RX Plus, see above
Contact & online information	Illinois Rx Buying Club Member Services: 1-866-215-3463                                                                       http://www.illinoisrxbuyingclub.com

Sources: Interview with Drug Advocate for the Governor;NCS: Summary of Law                                     Updated: 8/2007

IOWA	Iowa Drug Card.com
The Iowa Drug Card program provides discounts averaging 30 percent, with some up to 70 percent.  It is available to anyone who signs up, with no age, income or insurance status requirements.  It was announced and launched online June 2008.
Eligibility	Everyone is eligible for the card regardless of age and income.  Online sign-up requires only "name" and "email" - no address or state is requested or required.  Persons unable to register online may "pick up a card at K-Mart and other participating pharmacies."
Disabilities coverage	Yes.
Benefits	The program issues pre-activited enrollment cards onlince and covers brand name and generics; the program claims "most savings average 30-percent;" on some generics savings are  "as much as 70%."  Participating pharmacies include the following: "Kmart Pharmacy, Walgreens, CVS/pharmacy, Rite Aid, and Hy-Vee, as well as thousands of independent pharmacies."
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	n/a
State laws	not created by statute.
Special features & issues	The program was established as a non-profit, without stateutory or agency regulation.  The online sign-up form asks only three simple questions and allows instant printing of a personalized Iowa Rx Card for each family member.  The personalized card is described as "works like a free Rx drug coupon."
Other Rx programs	No; the Iowa Priority Prescription Savings Program provided discount coverage to specified residents from 2001-2005, but ended in 2006.
Contact & online information	Lila Cedotal, Development Director, Iowa Drug Card  www.Iowadrugcard.com An affiliate of www.FreeDrugCard.us

Sources: Program Web Site; News release RadioIowa 6/23/2008               Updated: 6/23/2008

IOWA	Iowa Priority Prescription Savings Program-- No longer operational -- see ARCHIVE

KANSAS	CommunityRx Kansas
CommunityRx Kansas provides a discount at the retail counter for uninsured residents who meet the requirement of annual income up to $29,400 for an individual, with discounts of 15 percent and up.
Eligibility	State residents who do not have access to prescription drug coverage. Must be a resident of Kansas and meet the household annual income requirements of $29,400 for an individual, 39,600 for a couple and, 49,800 for a family of three. (approximately 287% of federal poverty).  There is a $10 enrollment fee for each household.
Disabilities coverage	Yes, if conditions stated above are met.
Benefits	At least 286 pharmacies participate in the program, through two networks of Kansas pharmacies—Prescription Network of Kansas and Right Choice Pharmacy. Those eligible see "savings between 15 and 80 percent of the normal costs of prescription medications."
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	Since the program's implementation in January 2006, 950 enrollees have participated.
State laws	Program came as a result of Governor Kathleen Sebelius and the Office of Health Planning and Finance
Special features & issues	Program administered as of July 1, 2006 by the Kansas Health Policy Authority.
Other Rx programs	Yes, also authorized a Medicare-Medicaid dual-eligible Copayment plan.
Contact & online information	Division of Health Policy and Finance 785-296-3981           http://www.healthykansas.org/communityrxkansas.html

Sources: Interview with representative of Division of Health Policy and Finance; NCSL summary of law                   Updated: 6/2007

MAINE	Maine Rx Plus Program
Maine Rx Plus was originally created by a 2000 state law; it became operational in 2004 after a largely favorable ruling by the U.S. Supreme Court.  The program offers retail counter savings of 15 percent on name brands and up to 60 percent on generics.
Eligibility	State residents who meet income requirements of up to 350% of the 2007 federal poverty level. An Individual gross annual income must be under $35,735, a couple must be under $47,915. There is no age requirement and no enrollment fee. Enrollees only pay the cost of prescriptions.
Disabilities coverage	Yes, if otherwise qualified.
Benefits	All members save up to 15% on name brand drugs and up to 60% on generic drugs. Low Cost Drugs for the Elderly and Disabled also receive cost savings as Maine Rx Plus Members
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	37,198 as of June 2007
State laws	2003 LD 1634/ SP 560 (signed 6/13/03) U.S. Supreme Court favorable ruling 5/19/03 Operational 4/2004
Special features & issues	This program was initially authorized in 2000 but implementation was delayed by challenges in federal court and ultimately upheld by the U.S, Supreme Court in May 2003.
Other Rx programs	Yes. Also offers a subsidy program, Low-Cost Drugs for the Elderly and Disabled Program
Contact & online information	Bureau of Medical Services To enroll: 1-866-796-2463 207 287-2674

Sources: Interview with Director of Pharmaceuticals                                                                                            Updated: 7/2007        

MARYLAND	Primary Adult Care Program
The program is open to residents under age 65 with individual annual incomes up to $11,844 who enroll.
Eligibility	This program replaced the Maryland Pharmacy Assistance Program, effective July 2006. State residents under the age of 65 who do not qualify for Medicare or Medicaid and meet the income requirements. For 2007-08 Individual annual income must be not more than $11,844; a couple must be equal to or less than $13,692, or about 113.8% of FPL; assets cannot be more than $4,000.
Disabilities coverage	Yes, if otherwise qualified.
Benefits	A $2.50 co-pay for generic and preferred brand name drugs and a $7.50 co-pay for non-preferred brand name drugs. The program also provides free visits to a family doctor or Primary Care Provider.
Medicare wrap around	No; Medicare enrollees are disqualified; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries
State laws	2005: HB 1143  law effective  6/1/05
Special features & issues	The 2005 law allows for qualify residents to be within 175% of federal poverty level; see "eligibility" above for current requirements. Maryland Pharmacy Discount Program
Other Rx programs	Yes, see MD subsidy program above. Maryland Senior Prescription Drug Assistance Program (SPDAP)
Contact & online information	Maryland Pharmacy Assistance 1-800-226-2142    PAC Program Application, P.O.Box 386, Baltimore, MD 21203-0386  www.dhmh.state.md.us/mma/pac/index.htm |  Click for Application [updated 2/08]

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

MICHIGAN	MI Rx Prescription Savings Program (MiRx)
The Michigan MiRx program provides retail counter discounts to residents of all ages who lack Rx coverage and have annual incomes up to $27,930 annually.  Estimated average savings are 20 percent per prescription.
Eligibility	No minimum age; must have no prescription drug coverage and must be a state resident. Eligibility is based upon sliding income scale. Individual annual income must be equal to or less than $27,930. A Couple must be under or equal to $37,470 the income limit. There is no enrollment fee for this program.
Disabilities coverage	No, intended for people without coverage.
Benefits	Beneficiaries will save approximately 20% on each prescription.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	Est. 50,000-200,000-- updated number pending as of 7/07
State laws	2004 Governor's initiative
Special features & issues
Other Rx programs	No; the previous MI senior subsidy program was terminated December 31, 2005 and replaced by federal Medicare Part D.
Contact & online information	Michigan Dept. of Community Health: 1-866-755-6479 (Online application form) http://www.mihealth.org/mirx/mirx_brochure/mirx_brochure.pdf

Sources: MI RX Website; NCSL summary of law                                                         Updated: 8/2007

MONTANA

Prescription Drug Plus Program - Never implemented - See Archive

NEW HAMPSHIRE

Prescription Drug Discount Program for Seniors (2000-05)  See Archive

NEW MEXICO	New Mexico Discount Prescription Drug Program
In 2006, The New Mexico Discount Prescription Drug Program was expanded to all New Mexico residents, also replacing an earlier New Mexico SenioRX program.  It provides a retail counter discount averaging 13 percent on brand names and up to 50 percent on generics.
Eligibility	All New Mexico state resident are eligible for the program. State residents who already have prescription drug coverage are still eligible for the program and can choose to use whichever program whether it be their prescription drug coverage or the New Mexico Discount Prescription Drug Program that benefits them the most. There is no enrollment fee or premium costs for the program. Once a state resident signs up there is no need to reapply annually, residents are enrolled in the program until they request to cancel.
Disabilities coverage	Yes, every state resident is eligible and can choose which is more beneficial if they have multiple options on prescription drugs.
Benefits	Enrollees can save up to 50% on generic drugs and an average of 13% on brand name drugs. Over 300 pharmacies participate in the program and accept the discount card.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	6,625 enrollees as of 7/25/07
State laws	2005: SB 689, signed as Chapter 160, 4/5/05
Special features & issues	.
Other Rx programs	Not currently.  See archive
Contact & online information	Operational, 2006 Administered by the NM Retiree Health Care Authority 1-866-244-0882.

Sources: NCSL summary of law; Interview with Representative of New Mexico Health Care Authority                                     Updated: 8/2007

OHIO	Ohio Best Rx    formerly Golden Buckeye Prescription Drug Savings Program
The Golden Buckeye Prescription Drug Savings Program has merged into the Ohio Best RX Program.  Seniors with a Golden Buckeye card receive prescription drug discounts through the Ohio Best RX Program. Legislation that enacted the Ohio Best RX program has since been amended to expand eligibility requirements to include all state residents, with annual income limits only for those under age 60, set as up to $30,630 for an individual.
Eligibility	State residents over the age of 60 are automatically enrolled regardless of income.  State residents under the age of 60 can not have any insurance coverage to be eligible for the program.  In order to be eligible under the age of 60 a state residents must meet the an income requirement which requires them to make equal to or less than 300% of federal poverty guidelines, which equal $30,630 for an individual and $41,076 for a family of two.  There is no enrollment fee.
Disabilities coverage	Yes, if otherwise qualified; no age limit applies.
Benefits	Average savings to each enrollee is approximately 34% monthly for each participant. Seniors who are also covered by Medicare Part D can still use the card for saving on out of pocket expenses.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries
State laws	2002: SB 261, §173.06  signed 6/5/02
Special features & issues	As of July 2007 the Ohio Best RX Program is administered by the Department of Aging.  Amendments to the original program have expanded eligibility from 250% of FPL to 300% of FPL; prior to the amended requirements state residents under the age of 60 had to wait three months before being eligible for the program if they went without health insurance. Now state residents who once had health insurance and no longer do, do not need to wait the three months to be eligible for the program.
Other Rx programs	(Sec. 185.02.) Created the Office of Pharmaceutical Purchasing Coordination in the Department of Administrative Services. [2/2008]
Contact & online information	Operational as of October 2003 July 2007 the Department of Aging began to administer the Ohio Best RX Program: toll-free: 800 301-6446

Sources: Interview with Representative from the Ohio Department of Aging;NCSL summary of law                                     Updated: 7/2007, 2/2008.

OKLAHOMA	Oklahoma Prescription Drug Discount Program
The Oklahoma Prescription Drug Discount Program was launched April 1, 2007 aimed at any state resident lacking prescription drug insurance coverage. Retail counter savings are estimated at 10 to 50 percent.
Eligibility	Any state resident who is defined as uninsured or underinsured without prescription drug coverage. There is no minimum age requirement. Enrollment is free if your income is less than 150% of federal poverty level and $9.95 per year if greater. There is no income limit.
Disabilities coverage	Yes, if otherwise qualified
Benefits	Over 570 pharmacies participate in the discount card program. Savings on prescription drugs can be from 10 to 50%.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	The program was implemented on April 1, 2007. For the months of April and May there was a total of 346 enrollees.
State laws	2005:SB 547 Chapter 419, signed 6/6/05
Special features & issues	.
Other Rx programs	Yes; "RX for Oklahoma" is a clearinghouse that helps Oklahomans access prescription assistance programs provided by pharmaceutical manufacturing companies. Online information: http://www.health.state.ok.us/program/apep/RXDeveloper.html
Contact & online information	OK Health Care Authority 405-522-7300                                                                                                        www.okrxdiscount.com

Sources: Interview with Oklahoma Health Care Authority; NCSL summary of law                                     Updated: 7/2007

OREGON	Oregon Prescription Drug Program (OPDP)
A 2003 state discount program was significantly expanded by a 2006 binding ballot measure.  Beginning January 2007, any state resident lacking prescription drug coverage may enroll, with no age or income limits.
Eligibility	As of January 2007, the program was extended to include all state residents who are uninsured or underinsured and do not otherwise have prescription drug coverage. There is no enrollment fee and there is no maximim income requirement.
Disabilities coverage	Yes; see eligibility above.
Benefits	Enrolled residents receive a card entitling them to discounts on prescription drugs up to 60%.  Persons enrolled in Medicare Part D prescription coverage are still eligible for this program.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	86,000 as of September 25th, 2008.
State laws	2006 expansion: Ballot Measure 44 (Full Text) approved by voters 11/7/06.   Expanded program began 12/8/06
Special features & issues	Effective February 1, 2007, OPDP joined the Washington Prescription Drug Program to form the Northwest Prescription Drug Consortium.  The Consortium entered into a contract with The ODS Companies for pharmacy benefit administration.
Other Rx programs	Not in 2007 - see archive.
Contact & online information	Oregon Prescription Drug Program of the Oregon Health Policy and Research Agency contact: Betty Wilton  Phone: 503-373-1603 ; Toll-free: 888-411-6737   on-line description - http://www.oregon.gov/OHPPR/OPDP/index.shtml

Sources: OPDP Website; Interview with Representative; NCSL summary of law                                     Updated: 9/2008

RHODE ISLAND	Prescription Drug Discount Program for the Uninsured
Beginning October 2006, residents under age 65 without prescription drug coverage may enroll to receive retail counter discounts.
Eligibility	State residents who are uninsured and between the ages of 19 and 65. Must also have an annual income level equal to or less than 200% of 2006 federal poverty level, for an individual it is $19,600 annually. Enrollment fee is $20.00 per year.
Disabilities coverage	.
Benefits	.
Medicare wrap around	No, persons 65 and over and not eligible; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	20 as of 11/06 need update
State laws	2004: S.2886  RI GL § 42-66.2.1-3;  2006: Rules/Regs
Special features & issues	.
Other Rx programs	Yes. Also offers a direct subsidy program, Rhode Island Pharmaceutical Assistance for the Elderly (RIPAE)
Contact & online information	Program Operational as of September 2006 Department  of Elderly Affairs: 1-800-752-8088 (application)

Sources: Interview with Department of Elder Affairs; NCSL summary of law                                     Updated: 8/2007

SOUTH CAROLINA

South Carolina Retirees and Individuals pooling together for Savings (SCRIPTS) See ARCHIVE

SOUTH DAKOTA

Senior citizen prescription drug benefit program - Never operational;  See ARCHIVE

TENNESSEE	Cover Rx (discounts)
Cover Rx was enacted into law in 2006 as part of a broader state health coverage package.  The prescription drug discount component applies to any drug not on the CoverRx formulary.  Generic drugs on the formulary are covered by a sliding scale subsidy [see Cover Rx-subsidy above].  CoverRx was launched in January 2007.
Eligibility	Any Tennessee resident of at least six months between the ages of 19 to 64, who is a US resident or qualified alien, with an income at or below 250% of poverty level, and with no prescription drug coverage may be eligible. A single person household income level must be under $25,525 and a couple must be under $34,225. Costs to participate vary according to income level. For covered generics, a 30 or 90 day supply for a person below the federal poverty level is $3; a person between FPL and 149% of FPL pays $6 for a 30 day supply and $12 for a 90 day supply; and participants between 150% to 250% of FPL pay $10 per prescription for a 30 day supply or $20 for a 90 day supply.
Disabilities coverage	No, unless otherwise qualified as uninsured or underinsured.  See Eligibility above
Benefits	Over 250 medications are included within the pharmacy assistance program. There is a five script limit per month, however, insulin and diabetic supplies do not count against the limit. Beneficiaries receive discounts on any drug above the five script limit or any drug not covered by the program.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
# of beneficiaries	26,548  (as of 8/29/07)
State laws	Signed 6/12/06.   Operational Jan. 2, 2007
Special features & issues	Cover Rx combines features of a discount-only program with features of a subsidy (SPAP) program.  It is part of a 5-part health program called "Cover Tennessee." The formulary list is administered by ExpressScripts.
Other Rx programs	Yes, there is also a subsidy part of Cover RX, see above.
Contact & online information	Cover TN telephone: 1-866-CoverTN;   http://www.covertn.gov/cover_rx.html

Sources: Cover Rx Website; NCSL summary of law                                                     Updated: 9/13//2007

TEXAS

See ARCHIVE

VERMONT	Healthy Vermonters (Plus) Discount Program
This 2002 state discount program was aimed at residents over 65; the current program defines eligibility as any age, with income at or below 300 percent of federal poverty.
Eligibility	The program is intended for people without prescription drug coverage or those who have commercial plans with an annual limit.  For residents of any age with income at or below 300 percent of federal poverty. This translates to monthly income of $2245 for a household of one, $3030 for a household of two, and $3815 for a household of three. If a resident is over the age of 65, or disabled and receiving Medicare or social security benefits and have an income at or below 400% of FPL. A monthly income equal to or less than $2,994 for an individual or $4,004 for a couple.
Disabilities coverage	Yes, if otherwise qualified for Medicare or social security benefits.
Benefits	Beneficiaries are able to receive discounts equal to those of Medicaid rates.
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	Projected number of individuals enrolled for State Fiscal Year 2008 is approximately 8,841.
State laws	2002: H.31 signed as Act 127; Program was implemented July 2002
Special features & issues	.
Other Rx programs	Yes. VT also offers VPharm as a subsidy, see above.
Contact & online information	Department of PATH, Tel: 802-241-2992   Members: 1-800-250-8427          http://www.path.state.vt.us/Programs_Pages/Healthcare/Healthy_vermonters.htm

Sources: State web site; conversation with PATH agency; NCSL summary of law                                     Updated: 7/2007

WASHINGTON	Washington Prescription Drug Program (WPDP)
In March 2007, the Prescription Drug Program was launched with a goal of offering state-negotiated discounts to all interested residents, regardless of income, age or current insurance coverage.
Eligibility	State residents of all ages, all incomes. No restriction based on current insurance coverage. No enrollment fee.  Note: Persons with Medicaid or comprehensive employer-based insurance are eligible but will not be able to use a state discount and an insurance payment for the same purchase.
Disabilities coverage	Yes, no restrictions as above.
Benefits	Stated goal is to negotiate discount prices for "average savings" of 20 -percent on brand-name drugs and 60 percent on generic drugs. Actual discounts depend on agreements with individual manufacturers and distributors.  Purchases can be made at participating local pharmacies or by mail-order.  Average savings described as $26 per prescription. (10/07)
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	91,000 enrolled as of 9/25/2008
State laws	2005 bulk purchasing law, SB 5471, now: RCW 70.14.060 (1):
Special features & issues	The program is the first to use multi-state bulk purchasing as a strategy for obtaining discounts, in partnership with Oregon. The multi-state bulk purchasing partnership with Oregon is called the Northwest Prescription Drug Consortium. Total prescription drug charges: $11,065,041 * Total spent by Card members: $6,418,209 Total number of prescriptions filled: 195,908 Total savings by Card members: $4,646,831; Average savings per prescription: $22 or 41%; Average percentage of generic Rx: 81%  The WPDP Discount Card group is saving over $300,000 each month** News: "Governor Gregoire Announces Washingtonians Have Saved Over $1 Million on Prescriptions" 10/25/07.
Other Rx programs	Yes. Washington offers a special-purpose subsidy program: Medicare Copayment Plan, see subsidy above.
Contact & online information	The Prescription Drug Program, Washington State Health Care Authority Ray Hanley, Washington Prescription Drug Program Manager Phone: 360-923-2786 Online Description at http://www.rx.wa.gov/

Sources: **Interview with Washington State Health Care Authority 9/29/08; NCSL summary of 2005 law & 2006 Northwest.          Updated: 5/2008, 9/2008

WEST VIRGINIA	WV Pharmaceutical Discount Program Golden Mountaineer Discount Program
The West Virginia discount program provides a retail counter discount for uninsured residents of any age with annual income up to 200% of federal poverty.
Eligibility	Pharmaceutical Discount Program has no minimum age and is  for "uninsured residents".  Eligibility: single: $19,140; couple: $25,660  (200% FPL) Golden Mountaineer: State residents age 60 and older. Most beneficiaries are automatically enrolled. There is no income requirement or enrollment fee.
Disabilities coverage	Yes, any resident over the age of 60.
Benefits
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	350,000 (estimate), the bulk of cards are automatically issued upon drivers license renewal at the age of 60.
State laws	2004 law: HB 4084, Signed 4/7/04
Special features & issues	Began 9/01
Other Rx programs	West Virginia Rx. This public-private partnership will provide free prescription drugs to uninsured residents whose incomes fall below 200 percent of the federal poverty level.  Launched February 1, 2008, the program establishes an almost paperless “central fill” pharmacy. Providers may e-mail their patients’ prescriptions to the central fill pharmacy, which will fill and mail the prescribed medications to patients within a day or two. The state plans to combine $140,000 from its general fund with donations from the Benedum Foundation and Heinz Family Philanthropies to create the system. Drug manufacturers will donate the medications. “It has been estimated that the $100K investment will save about $350 million in future health-care costs,” said Senator Stollings.  Two community health centers will administer the program—Beckley Health Right will process the applications and West Virginia Health Right in Charleston will ship the medications. Patients must fill out an application, provide proof that their income falls below 200 percent FPL and pay a to-be-determined application fee, but no co-pays.  The idea for WVRx came from the 2004 West Virginia Pharmaceutical Availability and Affordability Act (HB 4084). The bill established a database for low-income and uninsured residents to help them connect to public and private drug assistance programs. It also created a pharmaceutical cost management council, which recommended that a central fill pharmacy be created. Implementation of the pharmacy was delayed until this year due to drawn out debates between the parties involved.
Contact & online information	Bureau of Senior Services 304-558-3317 or toll-free at 1-877-987-3646

Sources: Interview with Representative from the WV Bureau of Senior Services; NCSL summary of law                        Updated: 7/2007

WISCONSIN	Badger Rx Gold
Badger Rx gold provides a retail counter discount for any resident that lacks prescription drug insurance coverage if the person enrolls and pays the annual enrollment fee.
Eligibility	Any state resident that does not have health insurance, resident that has health insurance that does not cover prescription medications, the specific medication they need, or the co-payment is too high. There is no minimum age requirement or any other type of screening. Enrollment fees are $25 for an individual or $75 for a family. There is a $5 discount for online enrollment.
Disabilities coverage	Yes, any state resident if otherwise qualified.
Benefits	Badger Rx Gold saves enrollees 25-40% on prescription medications
Medicare wrap around	No; Not a qualified SPAP; payments do not count toward TrOOP.
Est. # of beneficiaries	7,000 as of March 2006
State laws	2003 Act 33; 2005 expansion to allow businesses to participate.
Special features & issues	.
Other Rx programs	Wisconsin is one of six states in the I-Save-Rx program that provides a portal for purchase of prescription drugs from state-approved Canadian venders.
Contact & online information	Description Online  Badger Rx Customer Service: Tel:1-866-809-9382

Sources: Interview with Pharmacy Representative on Legislative Council                                          Updated: 8/2007

Eligibility standards: The figures listed in these charts are based on language in state statutes or other state regulations. They are examples of the scope of individual programs; they are not intended as full descriptions of eligibility requirements for individuals. Please consult state program links and contacts for additional details and conditions.

Federal Poverty Guidelines are issued annually, and are used widely by federal and state programs as a measure of income eligibility.  Many state laws and programs, and some federal programs refer to the specific maximum amount as a percentage of the "Federal Poverty Level" abbreviated as  FPL.  Tables and descriptions in this report use the term "FPL" to describe a percentage amount based on guidelines.  HHS Federal Poverty Guidelines Description, 2008

Social Security Disability Income (SSDI) federal standards and descriptions of disability are available on-line; see State Assistance Programs for SSI Recipients, 2006, released 9/06.  The link includes state-specific tables.  Many states have adopted the federal definition of disability as a standard for state Rx eligibility.

State Pharmaceutical Assistance and Tobacco funds

The availability of tobacco settlement funds was a substantial factor in stimulating discussion and legislative activity relating to prescription drug subsidies. The following states appropriated tobacco settlement funds toward state Senior Pharmaceutical Assistance programs in 1999-2003.  Most states continue use of these funds, appropriated annually.

• Delaware (S 420 of 2000; S. 6 of 1999) $7.5 million ; also 2001 legislation
• Illinois (HB 3872, HB 4437 of 2000); $35 million appropriated ; also 2001 legislation
• Indiana (S 108 of 2000) $20 million; also 2001 legislation
• Maine (LD 2510) $10 million for expanded coverage
• Massachusetts (H5300, sec 46(b) of 2000) $10 million - original 1996 program used tobacco tax revenue
• Michigan - FY2001 budget - $33 million for prescription drugs for seniors (signed 7/2000)
• Nevada (Ch. 538 of 1999) - 15 percent of total available revenue
• New Jersey (S2000 of 2000; $29 million in FY 2000; $38 million in FY2001, of which $25 million is authorized in FY 2001 budget) ; also 2001 legislation
• New York- $55.7 million for FY2001 for expansion of EPIC; funds reduce the cost of drugs and expand the program.
• North Carolina - $35 million for FY 2002 for expansion from 2,000 to up to 100,000 in 2002.
• Ohio earmarked up to $12 million in 2001 for a future emergency elderly prescription drug benefit. The discount program enacted in 2002 does not require direct state funding at this level.

Several other states expanded health services for seniors or low income populations, without earmarking the funds to a specific pharmaceutical assistance program.

NCSL Sources and Resources:

• Pharmaceuticals Overview - NCSL web-based menu page features recent news, publications and other facts.
• "Prescription Drugs: Frequently Asked Questions"  - 2007 update of a popular tool for state policymakers.  8/31/07. [7 pages, PDF ]
• Prescription Drug State Legislation, annual editions: 2008  |  2007  |  2006  |  2005  |  2004 - tallies of filed bills, including enacted new laws, updated regularly.
• Health Premium Tax Credits - NCSL report, November 2008.

• Resources on Pharmaceutical costs and access, 2007 - NCSL compilation of outside links to academic, government, industry and consumer perspectives - updated regularly.
• National Pharmaceutical Council: "Pharmaceutical Benefits Under State Medical Assistance Programs, 2005-06
• State Pharmacy Assistance Programs: A Chartbook - Commonwealth Fund, 8/04 [84 pages]
• State Assistance Programs for SSI Recipients, 2005, published by Social Security Administration, 9/05.  
• State Pharmacy Assistance Programs 2001: An Array of Approaches, by David Gross of AARP, 8/01
• State Pharmacy Programs: Assistance Designed to Target Coverage and Stretch Budgets. U.S. General Accounting Office, 9/00 - Catalog # GAO/HEHS-00-162, 32 pages.
• U.S. Office of Pharmacy Affairs: Overview of the 340B Drug Pricing Program - web page, updated 2007
• PhRMA's HelpingPatients.org - Interactive web site integrating information about products from 48 Rx manufacturers.

APPENDIX I: Federal Definition of "SPAP" roles and MMA

     "The MMA allows SPAPs to “wrap around” the Medicare benefit to fill gaps in coverage and for State programs that meet the definition of “SPAP,” the program’s wrap-around payments will count as if they were paid by the beneficiary for purposes of filling the coverage gap and meeting the catastrophic limit. As a result, SPAPs will be able to provide the same or better coverage for beneficiaries who receive coverage through state programs now, at a lower cost per beneficiary for the states because of the availability of the Medicare drug benefit. Coordinating with Medicare frees up significant amount of state funds, allowing for the expansion of the population served by state SPAP programs. In fact, we estimate that the savings that will accrue to States as a result of Medicare Part D displacing SPAP expenditures for low-income beneficiaries will be approximately $600 million per year, or about $3 billion over the five-year period from CY 2006-2010.
     A State program may still be considered an SPAP if some or all of its program funding is from private sources (for example, from charities or independent foundations), and payments made by SPAPs will count towards an enrollee’s true out-of-pocket costs (TrOOP). This will allow the enrollee to reach the catastrophic coverage faster, at which point the Medicare program pays for at least 80% of the costs."
-Source:  SPAP Assistance for Low Income Subsidy Eligible Individuals under the Medicare Prescription Drug Benefit, Leslie Norwalk, CMS, 2005

This document is updated regularly on the web at www.ncsl.org/programs/health/drugaid.htm

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