Medicare Drug Plans and PACE/PACENET
What is PACE / PACENET Coverage?
The Pharmaceutical Assistance Contract for the Elderly or “PACE” program is a lottery-funded program that provides prescription drug coverage to PA residents, age 65 and older, who meet the program’s income requirements:
Q: If I am enrolled in a Medicare Part D drug plan, will I still use my PACE or PACENET card?
Yes, show both cards at the pharmacy. This will let your pharmacist know to bill Part D first and bill PACE or PACENET second. It will also let your pharmacist know that you are entitled to all of the drugs that are available under PACE and PACENET.
Q: Will my co-payments be higher with PACE/PACENET and a Medicare Part D drug plan?
No, not for medications that are covered by PACE/PACENET. If your Part D drug plan charges higher copayments than you were paying under PACE/PACENET, the program will pay the difference if the pharmacy has the capability to bill more than one payer for a prescription claim. If you are taking medications that are not covered by PACE/PACENET, you will pay the Part D plan’s copay for those drugs. If you run into any confusion at the pharmacy, call your program’s toll-free number while you’re still at the pharmacy.
Q: What happens if my Medicare Part D charges lower co-payments than PACE/PACENET?
You will pay the lower co-payments when the Part D plan pays for medication.
Q: Many Part D plans stop their coverage after you reach a certain dollar limit. This is referred to as the “donut hole” or “coverage gap.” How will this work if I have PACE/PACENET?
You will not experience a “donut hole” or period of time when you have no prescription drug coverage. Instead, the PACE/PACENET program will fill in the gaps for covered medications, so that you can continue to get your prescriptions by only paying the PACE/PACENET copays.
Q: What happens if my Medicare Part D plan doesn’t cover all of the drugs that PACE/PACENET covers?
If your Part D plan has a restrictive drug formulary, PACE/PACENET will cover your prescription medications or work directly with the plan to process a prior authorization on your behalf so the drugs will be covered by your Part D plan.
Q: Can I go to any pharmacy I choose if I am in PACE and Medicare Part D?
No. You must use the pharmacies that are in your Part D plan’s network. If you decide to change pharmacies, check with your new pharmacy to make sure they participate in your Medicare Part D plan and PACE.
Q: If my Part D plan offers a mail-order service, can I use it?
Yes. However, the mail-order pharmacy must participate with the PACE Program in order for the program to help pay for your extra co-payments. Please have your doctor’s verify if the mail-order pharmacy is in the PACE network prior to submitting prescriptions for processing. Also, when you receive a three-month supply of your drug(s) by mail, you will pay up to three PACE/PACENET co-payments at once. For example, a PACE cardholder would pay up to $18 for a 90-day supply of generic medications.