PACE and PACENET

Prescription medicationsPACE and PACENET offer comprehensive prescription coverage to older Pennsylvanians and cover most medications that require prescriptions, including insulin, syringes and insulin needles. These programs are administered by the Pennsylvania Department of Aging and funded by the Pennsylvania Lottery.

There are no premiums or monthly fees charged to people who enroll. These programs do not cover over-the-counter medicines, medical equipment or doctor, hospital, dental or vision services. PACE plus Medicare offers eligible older Pennsylvanians one of the most generous prescription assistance plans in the United States. PACE/PACENET coverage is supplemented by federal Medicare Part D prescription coverage - offering older Pennsylvanians the best benefits of both programs. Older adults continue to receive the same prescription benefits while, in many cases, saving more money.

For information or assistance with the application process, call cardholder Services toll-free at 800-225-7223.

Eligibility for PACE/PACENET

To be eligible for PACE/PACENET an individual must be:

  • A Pennsylvania resident for at least 90 consecutive days prior to application
  • 65 years of age or older
  • Not eligible for pharmaceutical benefits under Medical Assistance
  • Meet the following financial criteria:

For PACE:

  • Total income for single person must be less than $14,500
  • Total combined income for married persons must be less than $17,700.

PACENET:

  • Total income for single person must be between $14,501 and $33,500.
  • Total combined income for married persons must be between $17,701 and $41,500.

Note: Income includes net Social Security income and gross total income from all other sources.

How PACE Works

PACE and PACENET are working closely with Medicare to coordinate both prescription programs. The most important fact to remember is that cardholders will not lose their PACE  and PACENET benefits, and they may save even more money on their prescription costs. What does this mean for PACE Cardholders also enrolled in Medicare Part D?

Remain Enrolled in PACE  

Although cardholders will be enrolled in Medicare Part D, they will not lose their PACE benefits. Cardholders will be able to receive the same, or better, prescription benefits that they receive today, and the PACE Program will be able to save money because Medicare will become the primary payer.

Payment of Part D Premiums for Pace Enrollees

The federal government, if approved for full extra help, or the PACE Program will pay the Part D premiums for PACE cardholders that enroll in a Part D plan up to the regional benchmark amount, which is $40.74 for 2022.

No Coverage Gaps for PACE Cardholders

With Part D and PACE, cardholders will not experience any coverage gaps because they can use PACE as a secondary prescription coverage. This means that PACE will pay for prescription medications not on the Part D plan's formulary and prescription medications filled during Part D coverage gaps, as long as the PACE program currently covers the medication.

Possible Lower Copayments

The copayment for PACE cardholders will not be any more than the standard PACE copayments of $6 for generics and $9 for brand-name medications. PACE will cover any copays in excess of the PACE copayment amount. However, if they have been approved for the extra help subsidy, their copayments will be $2 for generics and $5 for brands.

Mail-Order Services

Some of the Part D plans offer 90-day mail-order services. The PACE Program will allow a 90-day prescription as long as the cardholder's Part D plan offers this service and the cardholder is using a mail-order pharmacy that participates with the PACE Program.

Prescription Card

PACE cardholders will receive a prescription card from their Part D plan. Cardholders should show this card to their pharmacist in addition to their PACE card. The pharmacist will bill the Part D plan first and the PACE Program second. The cardholder does not have to keep track of their prescription expenses.

If a PACE cardholder elects not to enroll in Part D while they are enrolled in PACE, they will continue to receive the current benefits that they do today, which include a 1-month supply of medications for $6 or $9. 

PACENET Cardholders with Medicare Part D

What does this mean for PACENET Cardholders also enrolled in Medicare Part D?

Remain Enrolled in PACENET  

Although cardholders will be enrolled in Medicare Part D, they will not lose their PACENET benefits. Cardholders will be able to receive the same, or better, prescription benefits that they receive today, and the PACENET Program will be able to save money because Medicare will become the primary payer.

Elimination of PACENET Deductible

The $40 monthly deductible has been eliminated. PACENET cardholders that enroll in a Partner Part D plan will pay the plan's Part D premium directly to the pharmacy. (If not in a Partner Part D plan, the premium is paid directly to that plan). Depending on the Partner Part D plan, the monthly premium will range between $32.50 and $34.80.

No Coverage Gaps for PACENET Cardholders

With Part D and PACENET, cardholders will not experience any coverage gaps because they can use PACENET as secondary prescription coverage. This means that PACENET will pay for prescription medications not on the Part D plan's formulary and prescription medications filled during Part D coverage gaps, as long as the PACENET program currently covers the medication.

Copayments

The copayment for PACENET cardholders will not be any more than the standard PACENET copayments of $8 for generics and $15 for brand-name medications. PACENET will cover any copays in excess of the PACENET copayment amount.

Mail-Order Services

Some of the Part D plans offer 90-day mail-order services. The PACENET Program will allow a 90-day prescription as long as the cardholder's Part D plan offers this service and the cardholder is using a mail-order pharmacy that participates with the PACENET Program.

Prescription Card

PACENET cardholders will receive a prescription card from their Part D plan. Cardholders should show this card to their pharmacist in addition to their PACENET card. The pharmacist will bill the Part D plan first and the PACENET Program second. The cardholder does not have to keep track of their prescription expenses.

If a PACENET cardholder elects not to enroll in Part D while they are enrolled in PACENET, they will continue to receive the current benefits that they do today, which include a one-month supply of medications for $8 or $15. These cardholders will pay a premium that is equivalent to the regional benchmark Part D premium at the pharmacy when they get their prescription filled. The process will work the same as the previous PACENET deductible.

Authorized Representative

PACE and PACENET will act as the authorized representative for its cardholders to assess eligibility and apply for low-income subsidies, to select and enroll in Part D plans that best match their prescription and pharmacy profiles, and to undertake appeals from Part D plans denials of coverage or determination of non-preferred status for particular drugs.

For more information on how PACE and PACENET will coordinate benefits with Medicare Part D, call the program at 800-225-7223.

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