SPAP & Medicare Part D: 5 tips to get help with drug costs

What’s an SPAP?

Here’s the simple answer:

• SPAPs are state-funded programs designed to make prescription drugs more affordable for people on Medicare.

Sounds great, right? But here’s the thing…

• Not every state has a state pharmaceutical assistance program to help cover the cost of prescription medications that Medicare Part D does not pay for.

• And of the 45 states (plus Washington D.C. and Puerto Rico) that do have an SPAP, most have specific eligibility requirements based on income, health status, and other factors.

So how do you find out if your state has an SPAP, determine your eligibility, and apply to get help with prescription drug costs?

In this article, we’ll answer the following questions:

• What are SPAPs?

• How do you qualify for an SPAP?

• How do SPAPs work?

• How do you apply for SPAP help?

• What states have SPAPs?

If you’re looking for more info about state pharmaceutical assistance programs (SPAPs), check out these 4 tips that will help you.

What are SPAPs?

Just to give you a refresher:

• State pharmaceutical assistance programs or SPAPs are state-funded programs designed to make prescription drugs more affordable for people on Medicare.

Each state that offers an SPAP sets its own rules, but generally, these programs provide assistance with costs like:

• Monthly premiums for Medicare Part D plans

• Prescription co-pays

• Out-of-pocket costs for prescription drugs

Think of SPAPs as a safety net to help you manage the high costs of your medications.

Fun fact: Beginning in 2025, the maximum out-of-pocket cost for prescription drugs with a Medicare Part D plan is $2,000.

But if you need help to pay your part for prescription drugs, you may be eligible for a SPAP if your state has one.

How do you qualify for an SPAP?

To qualify for a state pharmaceutical assistance program, you typically need to meet specific eligibility criteria, which vary by state.

These programs are designed to help Medicare beneficiaries with prescription drug costs. Common requirements include:

• Age or disability: Most SPAPs are for individuals aged 65 and older or those with qualifying disabilities.

• Income limits: Many programs have income thresholds, so your annual income must fall below a certain level.

• Medicare enrollment: You must already be enrolled in Medicare Part D to qualify for most SPAPs.

• Health conditions: Some SPAPs are only available for people with specific health conditions like renal disease, mental illness or HIV/AIDS.

• Residency: SPAPs are state-specific, so you must live in the state offering the program.

Check your state’s SPAP website for detailed information, application forms, and required documents.

How do SPAPs work?

If you qualify for an SPAP, the program works alongside your Medicare Part D plan.

Here’s how it typically works:

• Cost sharing: SPAPs cover part or all of your premiums, co-pays, or deductibles.

• Coordination with Part D: SPAP payments count toward your Medicare out-of-pocket maximum, helping you reach your maximum faster.

• Coverage for specific medications: Some SPAPs focus on drugs for certain conditions, like cancer, diabetes, or mental health.

  
  

How do you apply for SPAP help?

Applying is easy, and eligibility requirements vary by state.

Here’s how to get started:

• Check availability: SPAPs are not offered in every state. Look up your state’s program to see if you qualify here.

• Determine eligibility: If your state has an SPAP, find out if you meet eligibility requirements.

• Gather documents: For most SPAPs, you’ll need proof of income, residency, and Medicare enrollment info to apply.

• Submit an application: Applications can usually be submitted online, by mail, or in person. Keep in mind, every state may have a slightly different application process you’ll need to follow.

  
  

What states have SPAPs?

Most states (in addition to: Washington D.C., Puerto Rico, and the U.S. Virgin Islands) offer some type of state pharmaceutical assistance program. Some states also operate more than one SPAP.

Here’s a list of states that offer SPAP programs, in addition to the five that don’t”

SPAP: Medicare Part D requirement

SPAP applicants must have a Medicare Part D plan to apply in the following states. Income and age requirements may also apply:

• Delaware

• Maine

• Massachusetts

• Minnesota

• Missouri

• Montana

• Nevada

• New Jersey

• New Mexico

• New York

• Pennsylvania

• Rhode Island

• Vermont

• Virgin Islands

• Wisconsin

  
  

Kidney or renal disease requirement

In addition to Medicare Part D, income and age requirements, SPAP applicants in these states must be diagnosed with kidney disease or renal disease:

• Delaware

• Pennsylvania

• Texas

• Wisconsin

  
  

SPAP: HIV/AIDS requirement

In addition to Medicare Part D, income and age requirements, SPAP applicants in these states must be diagnosed with HIV/AIDS:

• Alabama

• Arizona

• Arkansas

• California

• Colorado

• Connecticut

• District of Columbia

• Florida

• Georgia

• Idaho

• Illinois

• Indiana

• Iowa

• Kansas

• Kentucky

• Louisiana

• Maryland

• Michigan

• Mississippi

• Montana

• Nevada

• New Hampshire

• New Jersey

• North Carolina

• North Dakota

• Ohio

• Oregon

• Pennsylvania

• Puerto Rico

• South Carolina

• South Dakota

• Tennessee

• Texas

• Utah

• Vermont

• Virginia

• Washington

• Wyoming

  
  

States without SPAPs include:

• Alaska

• Hawaii

• Nebraska

• Oklahoma

• West Virginia

  
  

Other options for prescription help

State Pharmaceutical Assistance Programs are not the only way that beneficiaries can get help with Medicare premiums. Here’s another way:

The Low Income Subsidy program: also called LIS and Extra Help.

• Premium subsidies to Part D recipients within certain income levels.

• A licensed health insurance agent can help determine if you qualify and help you get enrolled.

  
  

Get more info about SPAPs and Medicare Part D

If you’re looking for a Medicare Part D plan to help you with prescription drug costs, give us a call at (844) 297-9010 to speak with a licensed health insurance agent or

We can help you choose a Medicare Part D plan that makes sense, and identify SPAP options in your state that may help you with prescription drug costs.