ConnPACE

Effective January 1, 2008

There is an annual increase in the income limits based on changes in the Social Security cost of living allowance.  Please note in this program, "income" is adjusted gross income for purposes of federal income tax plus any other income minus Medicare Part B premium payments.

Age or Disability

The ConnPACE program is limited to those 65 and older and the disabled.  "Disabled" means that an adult (18 yrs.+) must be receiving Social Security or Supplemental Security Income (SSI) disability benefits.

Benefits

Drugs covered

ConnPACE will pay part of the cost of prescription drugs, insulin and insulin syringes.  Unless your doctor specifies a brand name medication and the prescription is approved through a prior authorization process, generic drugs will be substituted.  Some medications are excluded from ConnPACE coverage:  antihistamines, contraceptives, cough preparations, diet pills, experimental drugs, less than effective drugs as determined by the Federal Food and Drug Administration, multivitamin combinations, products prescribed for cosmetic purposes, and smoking cessation gum.  Also not covered are drugs made by certain pharmaceutical companies.

For ConnPACE beneficiaries who have a Medicare Part D Plan, ConnPACE will not cover Part D eligible drugs that are on the formulary of the PDPs that the participants select.  Any non-Part D drugs prescribed will be covered by ConnPACE.

ConnPACE benefits are generally not available when insurance will cover any portion of the cost of prescription medications.  If, for example, an insurance policy only paid $2 for each prescription, this would preclude any ConnPACE payment. Under such circumstances it might be advisable to drop the drug benefit under the insurance policy.  ConnPACE does not provide coverage during any deductible period.  Benefits are available to those who have exhausted the medication coverage under an insurance or managed care contract.  For example, a person who has insurance coverage for $500 per year in medication costs will be able to obtain ConnPACE benefits for prescription drugs once the $500 benefit has been expended.

ConnPACE will allow up to a 30 day supply or 120 doses, whichever is greater, for each prescription. 

Medicaid spend-down

The entire cost of the ConnPACE prescription no longer counts toward meeting one's Medicaid spend down for those enrolled in a Medicare Part D Plan.  For those without Medicare, in order to properly inform the Department of Social Services of this total drug cost, a person on a Medicaid spend down needs to provide his DSS caseworker with a print-out from the pharmacy detailing the full cost of the prescription.

Co-payments, premiums and deductibles

In most circumstances, ConnPACE beneficiaries make a co-payment of no more than $16.25 for each prescription.  Those ConnPACE beneficiaries enrolled in low-income subsidies of Medicare Part D will see much lower co-payments.

For ConnPACE beneficiaries who have a Medicare Part D Plan, ConnPACE will pay the Part D monthly premiums.  During the Part D "doughnut hole" period, ConnPACE will cover Part D prescription drugs, but beneficiaries must pay a cost differential in addition to the regular $16.25 co-payment.  ConnPACE will also cover any drugs that are not classified as Medicare Part D drugs.

Any drugs purchased under ConnPACE that are lost, destroyed or stolen, can be replaced -- limited to two times per year if the ConnPACE beneficiary signs a sworn statement -- with another co-payment.

 Back to the Top of this Page