Pharmaceutical Assistance Contract for the Elderly (PACE)Program began July 1, 1984

PACE Needs Enhancement Tier (PACENET)Program began January 1, 1997

State Prescription Assistance Program

Funded by the Pennsylvania Lottery$216.2 million spent annually on prescriptions (2011)

PACE / PACENET Program

What is PACE / PACENET?

1.5 million are eligible for the program

Current Enrollment (Aug. 2012):PACE 111,000PACENET 178,000Total 289,000

Average PACE cardholderFemale, 79 years old, widowed, 4-5 disease states83% are enrolled in Medicare Part D

Who is Eligible for PACE / PACENET?

Of the 1.9 million older Pennsylvanians…

Pennsylvania resident

Age 65 or olderCan apply 30 days before 65th birthday – benefit effective on 65th birthday

Income – based on previous calendar yearPACE: less than $14,500 for single person

less than $17,700 for married couple

PACENET: less than $23,500 for single person less than $31,500 for married couple

Assets are not counted

Program Eligibility Requirements

Who Qualifies for PACE / PACENET?

Prescription drugs, including insulin, insulin syringes & needlesGeneric medications: $6 copay (30-day supply)Brand name medications: $9 copay (30-day supply)Can get 90-day supply with PACE & Part D

PACENETPrescription drugs covered including insulin, insulin syringes & needlesGeneric medications: $8 copay (30-day supply)Brand name medications: $15 copay (30-day supply)Can get 90-day supply with Part DPay PACENET deductible or Part D monthly premium

Program Benefit

PACE

PACE/PACENET coordinates benefits with Part DNo coverage gapLower copaymentsProgram pays Part D premium for most PACE cardholdersPart D deductible coverage for members with Part DPACE/PACENET is creditable coverage

Extra Help / Low Income SubsidyEnrollees with low income and few assetsProvides for no or reduced Part D premium and deductibleNo coverage gapLow copaymentsContact APPRISE Program for help in applying

1-800-783-7067

Part D and Low Income Subsidy

Medicare Part D

STANDARD MEDICARE PART D PRESCRIPTION DRUG BENEFIT, 2012

$320

$2,930

$6,730

Catastrophic Coverage 5%

Coverage Gap 50% After Brand Discount 86% After Generic Discount

Initial Coverage Phase 25% BENEFICIARY PAYS $652.50

BENEFICIARY PAYS $320

BENEFICIARY PAYS $3,725.50

TOTAL BENEFICIARY OUT-OF-POCKET (OOP) COSTS EQUALS $4,700 PRIOR TO CATASTROPHIC COVERAGE.

Deductible 100%

Total Drug Costs:Beneficiary OOP Costs:

PACE PLUS MEDICARE PART D PRESCRIPTION DRUG BENEFIT, 2012

$320

$2,930

$6,730

Catastrophic Coverage 5%

Initial Coverage Gap 12% After Brand and Generic

Discounts

Coverage Phase 12% BENEFICIARY PAYS $313

BENEFICIARY PAYS $38

BENEFICIARY PAYS $456

TOTAL BENEFICIARY OUT-OF-POCKET (OOP) COSTS EQUAL $807 PRIOR TO CATASTROPHIC COVERAGE.

Deductible 12%

Total Drug Costs:Beneficiary OOP Costs:

Comprehensive and aggressive drug utilization review with prescription payment stopped at pharmacy counter

Developed by physicians and pharmacists

Tailored for older patients

Goals are safety and effectivenessDoseDurationConcurrent Usage

Safe and Effective Rx Utilization

Program History

Physician focused medical exception process

Step therapy for selected therapeutic classesSulfonylurea, insulin or metformin before pioglitazone (Actos)Calcium acetate (Phoslo) before sevelamer (Renagel)

A-rated generic substitution

Drug utilization review coordinated with Part D drug plans

Supplemented by academic detailing since 2005

Safe and Effective Rx Utilization

Prospective Drug Review (since 1992)

Enrollment https://pacecares.magellanhealth.com

Phone 1-800-225-7223

PACE Portal https://papaceportal.magellanhealth.com

How Do You Reach the Program?