PACE / PACENET

Getting medicin onlinePACE 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. Under PACE Plus Medicare, 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 1-800-225-7223.

Eligibility for PACEP/PACENET
To be eligible for PACEPlus/PACENETPlus 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:

PACEPlus:

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

PACENETPlus

  • Total income for single person must be between $14,501 and $27,500.
  • Total combined income for married persons must be between $17,701 and $35,500.

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

How does PACE Plus work?

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

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

Payment of Part D premiums for PACEPlus enrollees. The federal government, if approved for full extra help, or the PACEPlus Program will pay the Part D premiums for PACEPlus cardholders that enroll in a Part D plan up to the regional benchmark amount, which is $37.03 for 2019.

No Coverage Gaps for PACEPlus Cardholders. With Part D and PACEPlus, cardholders will not experience any coverage gaps because they can use PACEPlus as a secondary prescription coverage. This means that PACEPlus 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 PACEPlus program currently covers the medication.

Possible lower copayments. The copayment for PACE Pluscardholders will not be any more than the standard PACEPlus copayments of $6 for generics and $9 for brand name medications. PACEPlus will cover any copays in excess of the PACEPlus 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 PACEPlus 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 PACEPlus Program.

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

If a PACEPlus cardholder elects not to enroll in Part D while they are enrolled in PACEPlus, they will continue to receive the current benefits that they do today, which include a one-month supply of medications for $6 or $9. What does this mean for PACENETPlus Cardholders also enrolled in Medicare Part D?

Remain Enrolled in PACENETPlus. Although cardholders will be enrolled in Medicare Part D, they will not lose their PACENETPlus benefits. Cardholders will be able to receive the same, or better, prescription benefits that they receive today, and the PACENETPlus 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 PACENETPlus Cardholders. With Part D and PACENET, cardholders will notexperience any coverage gaps because they can use PACENET as a secondary prescription coverage. This means that PACENETPlus 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 PACENETPlus program currently covers the medication.

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

Mail-order Services. Some of the Part D plans offer 90-day mail-order services. The PACENETPlus 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 PACENETPlus Program.

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

If a PACENETPlus cardholder elects not to enroll in Part D while they are enrolled in PACENETPlus, 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 (currently $37.03) at the pharmacy when they get their prescription filled. The process will work the same as the previous PACENETPlus deductible.

Authorized Representative. PACE Plus and PACENETPlus 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 PACEPlus and PACENETPlus will coordinate benefits with Medicare Part D, call the program at 1-800-225-7223.

Apply online at:
pacecares.magellanhealth.com