Prescription Advantage
For Medicare beneficiaries over the age of 65, Prescription Advantage, the Massachusetts state pharmaceutical assistance program (SPAP), works together with the Medicare drug coverage benefit to lower prescription drug costs for its members. Medicare is the primary drug insurance and Prescription Advantage is a secondary payer.
Prescription Advantage helps to pay a member’s Part D plan co-payments during the Medicare coverage gap (also known as the “donut hole”). Members are placed in one of six different assistance levels, (S0 – S5) based on income and household size.
If you are:
- Married with a combined income of less than $43,710 annually, or single with an income less than $32,490, you are eligible for Prescription Advantage and will pay no enrollment fee for this benefit.
- Married with a combined income between $43,711-$72,850 or single with an income between $32, 491-$54,150 you would pay an annual enrollment fee of $200 per person.
If you are a Medicare beneficiary under the age of 65, you may still be eligible for assistance. Income guidelines for the under 65 Medicare age group differ from the over 65 group. Contact Prescription Advantage for additional details.
Note: If you are under 65 and disabled, you may also be eligible for assistance. Contact Prescription Advantage for more information on eligibility.
The Pharmacy Outreach Program staff can review your information, including family size, income and medications, to assess which programs you may be eligible for. Contact the MCPSH Pharmacy Outreach Program at 1-866-633-1617 or Prescription Advantage at 1-800-243-4636.