The state of Pennsylvania offers two prescription assistance programs for its residents: the Pharmaceutical Assistance Contract for the Elderly (PACE), and the companion program PACE Needs Enhancement Tier (PACENET). Placement into one of these programs is determined by one’s annual income from the previous year and whether the applicant has Medicare Part D. Therefore, eligibility for the calendar year 2023 considers the applicant’s 2022 income for eligibility purposes.
Unlike many state pharmaceutical assistance programs, enrollment in a Medicare Part D plan is not a requirement for PACE or PACENET participants. However, PACE members are encouraged to enroll in a Part D plan. PACENET members who do not enroll are charged $41.08 (for 2023) in monthly premiums each month they use their PACENET benefit. All programs offer assistance in the form of very low co-payment amounts for prescription medications.
These programs have a similar name but should not be confused with Medicare PACE (Program of All Inclusive Care for the Elderly), which is a comprehensive care program, not prescription only assistance. Furthering the confusion, Medicare PACE in Pennsylvania is sometimes called LIFE (Living Independence for the Elderly).
To be eligible, seniors must meet the following criteria.
When calculating one’s income, Medicare Part B (medical) premiums should be excluded. This allows single participants with income approximately $1,600 higher than the number above to be eligible.
Assets are not considered when determining eligibility.
PACE will pay for a senior’s complete cost of medications except for the monthly co-payments of $6 for generic drugs and $9 for brand name drugs. PACENET has similar benefits but has co-payments of $8 for generics and $15 for brand name drugs. The above co-payments are for a supply of 30 days.
There are no costs to enroll in the PACE program. PACENET participants have a fee of $41.08 a month. However, if they enroll in a Medicare Part D plan, that fee is waived.
One can learn more about these programs by visiting the PACE homepage or by calling their toll free number at 800-225-7223.