Home » Healthcare System in US » State pharmaceutical assistance program

State funded drug assistance programs

Increased drug costs have contributed to the overall elevated cost of healthcare. Patients who are underinsured or uninsured can be put in a hard situation when facing increased drug prices. They may not be able to afford the expensive drugs, therefore, may choose not to pick up drugs from pharmacy. Or they may not adhere to the drug regimen. This may further deteriorate their health condition. To help vulnerable patients afford prescription drugs, each state has its own drug assistance program called state pharmaceutical assistance program (SPAP).

SPAP is a state-run program that provides financial assistance to eligible patients. Patients must meet a minimum income level set by the state government to be eligible to enroll in the program. SPAP eligibility and coverage vary from state to state. SPAP is funded by both the state and federal government. SPAP programs can help members pay premium of Medicare Part D, deductible and co-payments. The amount that SPAP programs cover depends on patients’ income level. There is also some cost, such as monthly premium, to enroll in the SPAP programs. There are different levels of SPAP programs, some pay Part D premium and all Part D cost-sharing. It also covers diabetic supplies and prescription drugs that are not covered by Medicare. However, some only cover maintenance medications that patients take for a chronic condition. For non-maintenance prescriptions, patients must pay his/her Part D plan’s copayment. For example, if a patient has diabetes and must take anti-diabetic medications every day. At the same time, he received a new prescription for antibiotics and needs to take it for 7 days. He/she only needs to pay $1 or $2 copayment for the anti-diabetic drug. But he/she may need to use Part D plan to pay for the copayment of antibiotics depending on his SPAP grogram level. For more information, please feel free to contact us.

In addition to the SPAP, some states also provide a subcategory of assistance programs. The program is known as a state discount program or prescription buying club. State discounted programs usually do not use subsidized state or federal funds to pay for the medications. However, they do have eligibility requirements too. Some state discount programs offer discounts to all residents; however, others are only available to Medicare users. This program is like 340B program which requires that participating drug companies provide discounts to some eligible healthcare organizations. To learn more about 340B program, please visit here.

Each state’s SPAP and discount program can be found from National Conference of State Legislatures website.