DISABILITY ISSUES
Vol. 20 No. 1

Assistance with Prescriptions

With the passage of the last Massachusetts state budget, not only was the funding of the Senior Pharmacy Program increased by $21.7 million, the rules of eligibility were expanded to include non-elderly people with disabilities. In the current session of the legislature there is a promising move to extend free prescription medication coverage to all elderly and persons with disabilities. While the current program is good, and a great improvement over the past, things may get even better in the near future. In the meantime, do not let these benefits escape you if you are eligible.

The Senior Pharmacy Program (SPP) provides up to $1,250 per year to help pay for prescription drugs. Prescriptions covered include all Therapeutic Classes except those excluded from MassHealth. Some prescription drugs may require prior approval from the Division of Medical Assistance. However, Insulin and disposable syringes with needles are included.

Who is Eligible?

In spite of the name, people with disabilities are included in the Senior Pharmacy Program. To be eligible you must:

l Be a resident of Massachusetts;

l Be age 65 or older OR, if under 65, work less than 40 hours per month and meet the disability guidelines of CommonHealth;

l Have a gross annual income less than $15,492 (individual) or $20,769 (married couple) [Married applicants may choose to apply as individuals]; and

l Not be enrolled in MassHealth or CommonHealth.

You may apply even though you have prescription drug coverage through your HMO or other insurance provider. SPP can help you pay for medication after you have exhausted your other insurance benefits.

Coverage is also available to those whose gross annual income is higher than the above limits, but less than $41,220, and who are experiencing high prescription expenses relative to their income. If you have particularly high medication costs, call the Division of Insurance to see if you qualify.

What is Provided?

Once enrolled, you will receive up to $1,250 per year to pay for prescriptions after any other prescription benefits from other sources are exhausted. At the time of purchase, co-payments are $3 for generic drugs, insulin and syringes and $10 for "brand name" drugs.

To apply, call the Division of Medical Assistance at (800) 243-4636(voice) or (800) 813-7787(TTD/tty).