State Pharmacy Assistance Programs: A Chartbook

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Prior to the enactment of the Medicare prescription drug benefit in December 2003, many states had implemented programs to provide prescription drug coverage to a portion of their elderly or disabled residents who did not qualify for Medicaid drug coverage. The first of these programs was established in 1975, and a majority of states now have some type of state prescription assistance program (SPAP) in place.

The Medicare Prescription Drug, Modernization and Improvement Act of 2003 includes language allowing states to "wrap around" the Medicare benefit to fill gaps in coverage and states are currently assessing whether and how they would coordinate benefits. Program benefit levels and eligibility requirements vary widely, as do the number of persons enrolled and the program costs.

Coordinating the state benefits with numerous privately administered drug or Medicare Advantage plans will be complicated, especially for states with high eligibility levels and generous benefits. At the same time, coordination with Medicare would free up a significant amount of funds for states, allowing them to expand the population served by their programs or to support other state-funded programs.

This report provides current national data and trends over time for SPAPs on the number and types of programs, eligibility requirements, program design, enrollment, benefit utilization, and program expenditures. For more detailed state-specific data, please refer to a supplemental chartbook available at www.cshp.rutgers.edu.

This report and the supplement provide a sense of the benefits that states have been providing to the Medicare population over the years and how these efforts compare generally with the new Medicare drug benefit. This chartbook is intended to serve as an information source about these programs. Unless otherwise stated, the data in the chartbook are from surveys of SPAPs conducted in 2000 and 2002 by the Rutgers University Center for State Health Policy. The results of the 2000 survey are also presented, with more detailed findings from case studies of specific state programs, in three reports published by The Commonwealth Fund.