PACE and PACENET (not to be confused with the Medicare/Medicaid program PACE) are Pennsylvania's prescription assistance programs for older adults. Through this program, qualified Pennsylvania residents ages 65 or older can receive low-cost prescription medications. 

Qualifications for these two programs are determined by the previous calendar year's income, and Social Security Medicare Part B premiums are excluded from income. 

PACE Qualifications: 

  • Patient must be age 65 or older 
  • Patient must be a Pennsylvania resident for at least 90 days prior to the date of application 
  • Patient cannot be enrolled in the Department of Human Services Medicaid prescription benefit 
  • If a patient is single his/her total income must equal $14,500 or less 
  • If a patient is married, the combined total income of the household must equal $17,700 or less

PACENET Qualifications:

  • Patient must be age 65 or older 
  • Patient must be a Pennsylvania resident for at least 90 days prior to the date of application 
  • Patient cannot be enrolled in the Department of Human Services Medicaid prescription benefit 
  • If a patient is single, his/her total income must be between $14,500 and $27,500
  • If a patient is married, the combined total income of the household must be between $17,700 and $35,500

PACE/PACENET Patients in Amplicare: 

It's easy to find your PACE/PACENET patients on Amplicare! Simply navigate to your "All Patients" report from the Amplicare homepage and filter patients by Plan BIN. The BIN/PCN/RxGroup for PACE is:

  • BIN= 002286 
  • PCN= 0000102286 
  • RxGroup= PACE

Copayments

PACE will pay for a senior’s complete cost of medications except for the monthly co-payments of $6 for generic drugs and $9 for brand name drugs. PACENET has similar benefits but has co-payments of $8 for generics and $15 for brand name drugs. These co-payments refer to a supply of 30 days. 

In addition, there is no cost to join PACE, but PACENET has a monthly premium of $37.18. month. This premium, however, will be waived if the patient enrolls in a Medicare Part D plan (although they will be subject to pay their Medicare Part D premium). 

When part of PACE or PACENET, a patient will never be charged MORE than the cost of his/her medication at one time. So if the cost of a medication is less than than the cost of the premium (PACENET or Medicare Part D) a patient owes, he/she will only have to pay the cost of the medication. The remaining premium amount will then be tacked onto the cost of the patient's next filled medication if this medication is filled in that same month or the following month. 

Enrollment in Medicare Part D Plans:  

While it is not required for PACE and PACENET patients to be enrolled in a Medicare Part D plan it is highly encouraged. PACENET has a monthly premium of $37.18, but patients enrolled in a Medicare Part D plan will have this fee waived. In addition, if patients are enrolled in one of PACE's partner Medicare Part D plans, they will pay this premium directly to their pharmacies rather than directly to the insurance provider. This will be added onto the cost of the medication being filled. If patients are enrolled in a Medicare Part D plan that is NOT partnered with PACENET they will still have their PACE premium waived, but they will pay their PART D premium directly to the insurance provider. PACE's partner plans for 2019 are Wellcare Classic S4802-080 and Silverscript Choice S5601-012. 


PACE
/PACENET also works with: 

  • Retiree/union coverage
  • Employer plans
  • Veterans Benefits 

What's Next? 

Now that you've got PACE/PACENET covered it's time to learn more about patients who have VA benefits

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