Cost-of-Living Increase Makes Some Seniors Ineligible for Pennsylvania Prescription Drug Assistance Program

Seniors in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly, or PACE, program, who received cost-of-living increases in their Social Security checks could lose their coverage or face higher cost-sharing because their incomes now exceed the program's eligibility limits, the Pittsburgh Post-Gazette reports (Snowbeck, Pittsburgh Post-Gazette, 6/12). Seniors with annual incomes of less than $14,000 per year for an individual and $17,200 for a couple are eligible for the program (Kaiser Daily Health Policy Report, 1/16). Seniors in PACE pay $6 for each prescription. Two years ago, the state Legislature passed a measure excluding Social Security cost-of-living adjustments from PACE's income calculations, but the provision applied only to individuals enrolled before Dec. 31, 2000. Thomas Sneddin, PACE program director, said, "If the Legislature doesn't do anything, then (next year) we'll no longer exclude cost-of-living adjustments and those people will come out of the program over the next year or two."

Possible Solutions
Some seniors who will no longer be eligible for PACE could receive coverage through another program called PACENET, which requires patients to pay a $500 annual deductible. The program also has copayments of $8 for each generic drug and $15 per brand-name medication (Pittsburgh Post-Gazette, 6/12). Income limits under PACENET are $17,000 for an individual and $20,200 for couples (Kaiser Daily Health Policy Report, 1/16). State lawmakers have proposed other options for the approximately 10,000 seniors who could be affected by the cost-of-living adjustments. State Sen. Tim Murphy (R) has proposed lowering the PACENET deductible to $350 for lower-income seniors. His bill also calls for drug company discounts that would "allow PACENET seniors working toward their deductible to buy medicines at a better price." In addition, state Sen. Lisa Boscola (D) has proposed a bill that would link income limits under PACE to the Social Security cost-of-living adjustments. Also, state Sen. Jack Wagner (D) has proposed a "permanent moratorium" on including the cost-of-living adjustments when determining PACE eligibility (Pittsburgh Post-Gazette, 6/12).