PACE and PACENET
Prescription Drugs for Older Pennsylvanians
and PACENET Programs:
The Pharmaceutical Assistance Contract for the Elderly
(PACE) and the PACE Needs Enhancement Tier (PACENET) assist eligible Pennsylvania residents, who are 65 years of age or older, with payment for their prescription medicines.
You are eligible for PACE if you have been a Pennsylvania resident for at least 90 consecutive days prior to application; you are
age 65 or older; and you had a total income for the preceding calendar year of
less than $14,500 for a single person, or less than $17,700 combined for a married couple living together.
You are eligible for
PACENET if you have been a Pennsylvania resident for at least 90 consecutive days prior to application; you are at least age 65 or older; and you had a total income for the preceding calendar year of
between $14,500 and $23,500 for a single person, or between $17,700 and $31,500 combined for a married couple living together.
You are not eligible for either program if your prescription drug costs are covered by a public assistance program.
Applying for PACE and PACENET:
You may obtain an application from your local area agency on aging, pharmacy, or legislator's office.
Or call Cardholder Services at 1-800-225-7223. Complete the form and send it along with proof of age,
income and residency to the PACE Program. You may apply 30 days prior to your 65th birthday.
You can also obtain an application at the Department
of Aging web site. Click on this link
www.aging.state.pa.us. Then go to the left hand side and click on
Prescription dosage limitations are a 30 day supply or 100 units, whichever is less. A unit refers to a tablet or capsule.
Medicines that are covered:
Only medicines which require a physician's prescription in order to be dispensed are covered. Insulin, insulin syringes and insulin needles are the only exceptions. Over-the-counter medications such as aspirin, antacid, vitamins, etc., and experimental drugs are not covered, even if prescribed.
Drugs appearing on the Federal Food and Drug Administration's (FDA) DESI listing are not covered
unless your physician writes "medically necessary" on your prescription. DESI drugs are those which the manufacturer has not presented the FDA with satisfactory evidence of efficacy and safety.
Therapeutic Drug Utilization Review (TDUR):
TDUR identifies PACE and PACENET cardholders whose drug use patterns place them at unnecessary risk for drug-induced illness. Each month, risk alerts are issued to physicians and pharmacists throughout Pennsylvania, bringing to their attention potentially high risk drug therapies of their patients.
Using a PACE and PACENET card:
You must present your card and prescription(s) at any pharmacy which participates in the PACE
and PACENET program. Virtually all pharmacies located in Pennsylvania participate. Out-of-state pharmacies cannot participate. Medications cannot be mailed out of Pennsylvania.
PACENET enrollees are responsible for a $40 per month
before PACENET will begin paying for prescriptions.
PACE members must pay a $6 copay for each
generic prescription filled by the pharmacist, or $9 for brand name medications. You will be required to pay any additional charge equal to fifty percent of the trade product price if you insist on a brand name medication when a multisource (generic) drug substitute is permitted by your physician and approved for substitution in Pennsylvania.
Once PACENET members have reached the $40 per month deductible amount,
(cumulative to $480 per year) they are
responsible for an $8 copay for generic prescription drugs and a $15 copay
for brand name prescription drugs.
For those who have other prescription drug coverage:
PACE pays only for that portion of your medicine costs which is not covered by your current plan. PACE is the
payer of last resort. Help keep the program in good financial health by providing PACE with your insurance information on your application.
For those in PACENET, the amount your insurance company pays toward your
prescriptions does not count toward your deductible, but any
copayments you make under your other plan do count.
Generic brand drugs vs. trade name drugs:
A generic brand drug contains the same active ingredients as its equivalent trade name drug and is found to be as effective. However, the generic drug is usually much less expensive. PACE strongly urges you to discuss the use of cost effective multisource (generic) drugs with your physician and pharmacist.
Renewing the card each year:
Your card is only valid for the period indicated on the front of the card. You will automatically receive your Renewal Application in the mail approximately two months before your card expires. Complete the application and return it to the PACE Program. It will not be necessary to provide any proof of age or residency documents with your Renewal Application. If you remain eligible, you will receive your new card before your current card expires.
Continuing to participate in PACE and PACENET:
Eligibility is subject to annual renewal. Your PACE benefits will be terminated if you move out of state; if it is determined that you have abused your
privileges or in some way defrauded the program; or you are eligible for prescription benefits under the state's Medical Assistance Program.
If your application is denied, or your PACE benefits are terminated by the Department of Aging, you have the right to appeal to the Department for a review of your case. Anyone who submits a false or fraudulent claim, or who claims duplicate benefits will be subject to punishment under Pennsylvania law.
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IMPORTANT TELEPHONE NUMBERS:
Devices for the Deaf (TDD)........1-800-222-9004
Calls Are Kept Confidential