A State Pharmaceutical Assistance Program (SPAP) is a state-funded program that helps people on Medicare pay their Part D premiums and drug copays. Most serve older adults, and several also take people under 65 who have a disability. Thirteen states run one we can source. No working federal roster of them exists, so we built the list ourselves from federal and state program lists, confirming each program on its own state's sources. It's below, along with the two questions behind it: does your state help pay for prescriptions, and how would a SPAP fit alongside Medicare's own Extra Help?

In This Guide

What a State Pharmaceutical Assistance Program Is

A SPAP is a program a state runs to help its residents, usually low- and middle-income older adults and, in several states, younger people with a disability, cover the out-of-pocket cost of prescription drugs under Medicare Part D. Federal law defines the term precisely. Under 42 CFR 423.464(e)(1), a state program is a SPAP for Part D purposes if it meets all of the following: it provides financial help toward supplemental Part D drug coverage, it treats every Part D plan the same rather than steering members into one plan, it meets the benefit-coordination requirements of the subpart, it does not adopt rules that change the primary-payer status of a Part D plan, it bases eligibility on financial need, age, or medical condition rather than on someone's job, and it does not make midyear or noncalendar-year plan enrollment changes for a substantial number of its members when it is authorized to do so on the member's behalf.

The load-bearing part of that definition is what it excludes. The same regulation states that the definition of a SPAP "excludes State Medicaid programs, section 1115 demonstration programs, and any other program where program funding is from Federal grants, awards, contracts, entitlement programs, or other Federal sources of funding." In plain terms: a real SPAP is paid for with state money. That funding test is what separates it from Medicaid and from the federally funded drug-assistance programs that, confusingly, share the same "SPAP" label.

Does Your State Have One?

Thirteen states do. Pennsylvania runs PACE and PACENET, New Jersey runs PAAD and Senior Gold, New York runs EPIC, Vermont runs VPharm, Wisconsin runs SeniorCare, Massachusetts runs Prescription Advantage (closed to new applicants after September 11, 2026), Maryland runs the Senior Prescription Drug Assistance Program (SPDAP), Maine runs Low Cost Drugs for the Elderly or Disabled (DEL), Rhode Island runs RIPAE, Missouri runs the Missouri Rx Plan (MORx), Montana runs Big Sky Rx, Indiana runs HoosierRx, and Delaware runs the Delaware Prescription Assistance Program (DPAP).,,,,,,,,,,

Eight also take some people under 65. New Jersey and Delaware take Social Security disability recipients, Rhode Island takes 55- to 64-year-olds on Social Security disability, Maine takes 19- to 61-year-olds meeting SSI disability criteria, Vermont takes people under 65 who are on Medicare, Montana and Maryland set no age requirement, and Massachusetts has a now-closed disability track.,,,,,, Pennsylvania, New York, Wisconsin and Indiana start at 65.,,, Missouri's isn't counted: MORx enrolls people on Medicare and MO HealthNet.

Three states have ended the programs they once ran, so older pages about them are out of date: Nevada's Senior Rx and Disability Rx ended on December 31, 2023, Illinois's program on July 1, 2012, and Connecticut's ConnPACE on January 1, 2014.,,

State Program What it helps with
Pennsylvania PACE and PACENET Broad wraparound help with drug costs; the state pays last, after Part D
New Jersey PAAD and Senior Gold PAAD: flat copays plus Part D premium help. Senior Gold: $15 plus half the remaining cost of each drug, and no premium help
New York EPIC Part D premium help, or a reduced EPIC deductible, plus capped copays
Vermont VPharm The Part D premium and cost sharing, for a monthly member premium set by income
Wisconsin SeniorCare Flat copays for a small annual fee, after an income-based deductible at every level but the lowest
Massachusetts Prescription Advantage Subsidized catastrophic drug coverage; the state pays last. Closed to new applicants after September 11, 2026; current members continue
Maryland SPDAP A monthly Part D premium subsidy only; enrollment is capped and waitlisted
Maine Low Cost Drugs for the Elderly or Disabled (DEL) A cap on what the enrollee pays for drugs on the program's basic list; the cap is weaker for brand-name drugs outside it
Rhode Island RIPAE A share of approved generic drugs bought during the Part D deductible stage
Missouri MORx Half of the member's Part D copays, for members who also have MO HealthNet; Missouri's own sources disagree on whether deductibles and leftover costs count. No premium help
Montana Big Sky Rx A monthly Part D premium subsidy only
Indiana HoosierRx A monthly Part D premium subsidy, for plans from a short participating list
Delaware DPAP A yearly dollar cap toward drugs and premiums, with a member copay

Follow any linked program name above for Brevy's full guide, or start with Pennsylvania's PACE and PACENET, Vermont's VPharm, or Maryland's SPDAP.

No federal roster will hand you that list. CMS's state-by-state SPAP look-up tool on Medicare.gov is no longer available. The list that surfaces in searches instead, a "best price" list on Medicaid.gov, exists to apply a drug-manufacturer pricing rule, not to guide families: it is opt-in, was last updated in 2023, and leaves out live programs, including several of the thirteen above. Treat it as a research clue, not a directory.

Published counts disagree so wildly because almost all of them count by name instead of by funding. 42 CFR 423.464(e)(1) excludes State Medicaid programs, section 1115 demonstration programs, and any program funded from federal grants, awards, contracts, entitlement programs, or other federal sources, whatever a roundup calls it. Apply that test and most of what carries the label falls out, which is the whole difference between the tallies in the dozens you will see quoted and the thirteen states above.

We built the list from federal and state program lists, then confirmed each program against that state's own agency, statute, or regulation rather than a national roundup. Programs change, so treat the list as current to 2026 and confirm with your own state.

Two of the thirteen carry an open question. Vermont's VPharm and Wisconsin's SeniorCare are each set up by their own state as a pharmaceutical assistance program, and each runs its spending authority through a section 1115 demonstration., The federal definition at 42 CFR 423.464(e)(1) excludes section 1115 demonstration programs. We found no CMS roster of federally qualified SPAPs that settles whether either counts for Part D purposes, so we don't pick between the state and the regulation. If the difference matters to you, for instance for the special enrollment period described below, confirm it with your state agency or your Part D plan.

How a SPAP Pays: Part D First, the State Wraps Around

A SPAP does not replace your Medicare drug plan. It sits on top of it. Federal rule 42 CFR 423.464(b) is explicit: "A Part D plan is always the primary payer relative to a State Pharmaceutical Assistance Program." Your Part D plan adjudicates each prescription first, applies its own price and copay, and only then does the SPAP step in to help with what you still owe, some of your premium, deductible, or copay, depending on the program's rules. That is what "wraparound" means.

A second mechanic carries a condition. Money a SPAP pays can count toward your Part D out-of-pocket limit, but the federal definition of "incurred costs" at 42 CFR 423.100 is a two-part test. The cost must be the right kind, chiefly a covered Part D drug your plan did not pay for because of the deductible or other cost-sharing, and it must be paid the right way, which is where the regulation counts costs paid "Under State Pharmaceutical Assistance Program (as defined in § 423.464)" among your incurred costs. SPAP help with a drug your plan covers moves you toward the point where the plan covers your drugs in full; help with a drug your plan does not cover does not. For 2025 and later years, help reimbursed through insurance, a group health plan, or certain other third-party arrangements generally counts too, except your own Part D or Medicare Advantage plan's basic drug coverage and manufacturer payments under the Manufacturer Discount Program. (For how the Part D out-of-pocket cap and its phases work, see our guide to how Medicare Part D works.)

State Pharmaceutical Assistance Program or Extra Help, or Both?

A search for state prescription help often turns up Medicare's federal Extra Help program instead. Extra Help, also called the Part D Low-Income Subsidy, is a federal benefit run through Social Security that lowers or eliminates Part D premiums, deductibles, and copays for people with limited income and resources. It is not a SPAP.

A SPAP is state-funded with rules set by your state; Extra Help is federal, with national income and resource limits. Whether you can have both is up to your state.

Some build on Extra Help. New York requires income-eligible EPIC members to apply for it, Vermont expects VPharm applicants to have secured it if eligible, Massachusetts requires anyone who may qualify to apply, and Delaware wants proof of it, if you're eligible, within 90 days of DPAP benefits starting.,,, In others, Extra Help can rule you out. Rhode Island's RIPAE is for people not enrolled in Extra Help, Maryland's SPDAP excludes anyone eligible for the full subsidy, Montana's Big Sky Rx is for people not eligible for federal Part D low-income help, and Indiana's HoosierRx needs Social Security's decision on your Extra Help application first and turns away anyone who gets the full subsidy.,,,

In most states, apply for Extra Help first. It's nationwide, free to try, and several state programs want Social Security's answer before they act. In Rhode Island, Maryland, Montana or Indiana, ask your SHIP how the two fit.

State Pharmaceutical Assistance Program (SPAP) Medicare Extra Help (Part D Low-Income Subsidy)
Who runs it Your state, with state funding The federal government, through Social Security
Where it exists Only in states that operate one Nationwide
What it helps with Part D premiums and cost-sharing, per the state's rules Part D premiums, deductible, and copays
Who qualifies Set by the state (income, age, or medical condition) Federal income and resource limits
How it affects your Part D out-of-pocket limit What it pays for a covered Part D drug counts toward the limit Lowers the premium, deductible, and copays you owe in the first place
Can you have both Depends on the state: some require you to apply for Extra Help, others exclude people who have it Available everywhere; your state's program rules decide whether you can add a SPAP

Two Programs That Share the Name but Aren't This

Two naming traps send people to the wrong program.

PACE is two different programs. Pennsylvania's SPAP is called PACE, short for Pharmaceutical Assistance Contract for the Elderly. Federally, "PACE" also means the Program of All-Inclusive Care for the Elderly, a Medicare and Medicaid program codified at 42 CFR Part 460 for people age 55 or older who need the level of care their state's Medicaid plan requires for nursing facility services and who live in a PACE organization's service area. Same four letters, completely different programs. If you're looking for help with drug costs and land on a page about all-inclusive medical care, you're on the wrong PACE.

"SPAP" and "State Pharmacy Assistance Program" get used for programs that aren't about Part D at all. Several states use the same label for their AIDS Drug Assistance Program (ADAP) or for kidney, cancer, or mental-health drug programs. The funding test from 42 CFR 423.464(e)(1) tells them apart: if a program is funded from federal grants, awards, contracts, entitlement programs, or other federal sources, it is not the Part D wraparound this guide is about, whatever the label says.

Can You Change Your Part D Plan Anytime?

A common claim online is that joining a SPAP lets you switch your Part D plan whenever you like. That's wrong, and acting on it can cost you.

Belonging to a qualified SPAP does give you a Medicare Part D special enrollment period under 42 CFR 423.38(c)(17), and it reaches both kinds of drug coverage: you can use it to join either a Medicare drug plan or a Medicare Advantage plan with drug coverage. The rule is specific: a member "is eligible to make one enrollment election per year." One change, not unlimited changes, and the cap applies to this special enrollment period alone, not to the fall Open Enrollment Period or any other special enrollment period you separately qualify for. The SEP is available while you're enrolled in the SPAP. If you lose SPAP eligibility, the window opens either the month your eligibility ends or the month you're notified of the loss, whichever is earlier, and it closes two calendar months after the later of those two.

The practical consequence: if you use that annual election to switch plans in March and then find a better fit in June, this SEP won't let you switch again that year, though the fall Open Enrollment Period still will. Spend the SPAP election deliberately. This special enrollment right is separate from the rules that decide whether you owe a Medicare Part D late enrollment penalty in the first place, which turn on whether you kept creditable drug coverage when you were first eligible.

What It Looks Like in One State: Pennsylvania

Pennsylvania's numbers show what "eligibility varies by state" means in practice. Its program, PACE and PACENET, is financed with Pennsylvania state lottery funds, and its day-to-day operations are run by a contractor under the guidelines of the Pennsylvania Department of Aging. It's open to residents age 65 and older who have lived in Pennsylvania at least 90 days and aren't already covered by Medicaid's prescription benefit, and eligibility turns on the prior calendar year's income. The governing regulation, 6 Pa. Code § 22.21, states those conditions conjunctively and carries a second disqualifier the program's consumer page does not repeat: an applicant must "not be qualified for payment for prescription drug benefits under a public assistance program or qualified for full coverage of prescription drugs under another plan of insurance or assistance." So full drug coverage from another plan can shut the door, even though Pennsylvania describes PACE and PACENET working alongside partial coverage such as Part D. Where the state draws that partial-versus-full line is not published, so ask the program. That regulation lists residency, age, income, and other drug coverage, with no asset or resource test among them.

PACE covers single applicants with income of $14,500 or less and married couples with combined income of $17,700 or less. PACENET, the upper tier, covers single applicants with income from $14,501 to $33,500 and married couples from $17,701 to $41,500. A cost-of-living moratorium, most recently extended by Act 49 of 2025, lets people who were enrolled as of December 31, 2024 keep their benefits when a Social Security raise nudges their income over the limit; that protection runs through December 31, 2027. Pennsylvanians can apply by phone at 1-800-225-7223, online, or by mail. PACE can also pick your Part D plan: state law has the Department of Aging enroll members in the plan it recommends unless they choose another, with at least ten days to decline. Our full guide to Pennsylvania PACE and PACENET walks through the tiers and the application in detail.

New York's EPIC (Elderly Pharmaceutical Insurance Coverage) sets its own income tiers and structure. Every state draws these lines differently, so check your own.

How to Find Out If Your State Helps

To confirm the details for your state, or whether a program has changed, go to the sources that know it:

  1. Contact your State Health Insurance Assistance Program (SHIP). Every state has a SHIP that offers free, unbiased Medicare counseling, and its counselors know whether your state runs a SPAP and how it interacts with Part D. Find yours through the national SHIP directory.
  2. Check your state's aging or health department directly. Search for your state's name plus "pharmaceutical assistance" or "prescription assistance for seniors," and confirm what you find on the state's own .gov site rather than an aggregator.
  3. Call the Eldercare Locator. The Eldercare Locator connects you to local aging services that can point you to your state's program if it has one.
  4. Apply for federal Extra Help in parallel. Whether or not your state has a SPAP, you can apply for Extra Help through Social Security. It exists nationwide, and several state programs ask you to apply for it first, though in a few states getting it can rule you out of the state program.,,

Frequently Asked Questions

Is a SPAP the same as Medicare Extra Help?

No. Federal rule reserves the SPAP label for a program the state pays for, and excludes any program funded from federal grants, awards, contracts, entitlement programs, or other federal sources. Extra Help is exactly that: a federal benefit, available nationwide through Social Security. The two are separate layers, and whether you can hold both depends on your state's rules. Apply for Extra Help first, then check what your state's program allows.

If I get Extra Help, do I still need my state's SPAP?

It depends on your state. New York, Vermont, Massachusetts and Delaware expect you to apply for Extra Help and work alongside it.,,, In Rhode Island and Montana, Extra Help can make you ineligible, and in Maryland and Indiana the full level of it does.,,, Where you can have both, your Part D plan is always the primary payer relative to a SPAP, so the SPAP wraps around whatever your plan leaves you owing, including costs Extra Help doesn't fully cover. What your SPAP pays for a covered Part D drug also counts toward your Part D out-of-pocket limit, though help with a drug your plan does not cover does not count. Check the details with your state or a SHIP counselor.

My state's program is called PACE. Is that the same as PACE for all-inclusive care?

Not necessarily. Pennsylvania's drug program is named PACE, short for Pharmaceutical Assistance Contract for the Elderly, and it helps residents 65 and older with prescription costs. The federal PACE, Program of All-Inclusive Care for the Elderly, is a separate Medicare and Medicaid program at 42 CFR Part 460 for people 55 or older who need a nursing-facility level of care. Check which one a page is actually describing.

Is there one national list of every state's SPAP?

Not an official one. The federal look-up tool is gone, and the lists online are outdated or built for another purpose. We built our own from federal and state program lists, confirming each program on its state's own sources: thirteen states run a program we can source, and they're listed above with the state source behind each.,,,,,,,,,, Confirm your state's details with its SHIP or its aging department before you rely on them.

Can I use my state's SPAP while I'm away for the winter?

Usually only through pharmacies back home, so plan before you leave. Pennsylvania's PACE pays only Pennsylvania pharmacies, apart from a Part D plan's main mail-order pharmacy, and won't mail drugs to an address outside the state. New Jersey's PAAD and Senior Gold don't cover drugs bought outside New Jersey. New York's EPIC requires a participating pharmacy in New York and suggests bringing enough medication and asking your Part D plan how it handles refills out of state. Wisconsin's SeniorCare generally won't pay pharmacies outside Wisconsin, and tells long-term travelers to have their pharmacy send drugs to them. Vermont's VPharm can pay an out-of-state pharmacy only if it's enrolled in Vermont Medicaid. Rhode Island's RIPAE allows mail order, but your eligibility ends if you move away and are no longer a full-time Rhode Island resident.

Can I switch my Part D plan whenever I want if I'm in a SPAP?

No. SPAP membership gives you a Part D special enrollment period that lets you join either a Medicare drug plan or a Medicare Advantage plan with drug coverage, but it allows one election per year, plus a short window if you lose SPAP eligibility. That cap applies to this special enrollment period only: the fall Open Enrollment Period, and any other special enrollment period you separately qualify for, still work as usual.

Learn More

MedicareHow Medicare Part D WorksMedicare Part D in 2026 and 2027: the $2,100 out-of-pocket cap rising to $2,400, the $615 and $700 deductibles, premiums, the late penalty, and Extra Help. MedicareMedicare Extra Help: The Part D Low-Income SubsidyMedicare Extra Help can cut Part D drug costs to a few dollars a prescription. See 2026 income and resource limits, what it pays, and how to apply. MedicareCreditable Drug Coverage and the Part D Late PenaltyWhat creditable prescription drug coverage means, the 63-day rule, what counts, and how to avoid the Medicare Part D late enrollment penalty in 2026. MedicareMedicare Late Enrollment Penalties: Parts A, B, and D ExplainedWorried you missed a Medicare deadline? Here is how the Part A, B, and D late enrollment penalties are calculated, how long each lasts, and how to avoid them. MedicarePennsylvania PACE and PACENET: How the State Helps Pay Your Medicare Drug CostsPennsylvania's PACE and PACENET help residents 65 and older pay Medicare Part D drug costs. See the 2026 income limits, no asset test, and how to apply.

Find personalized help figuring out whether your state helps pay for Medicare prescriptions at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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