Medicare Part D helps cover prescription drugs, but premiums, deductibles, and copays still add up fast. State Pharmaceutical Assistance Programs (SPAPs) are the safety net on top of that: state-funded programs that pay part or all of your out-of-pocket drug costs. If you live in one of the roughly 14 states with an active SPAP in 2026, you may qualify for significant additional relief, regardless of whether you already receive Medicare Extra Help (LIS).
This guide covers which states have active SPAPs in 2026, the income and age limits for each major program, how SPAPs interact with Medicare Part D and Extra Help, and how to apply. The 2026 Part D out-of-pocket cap is $2,100. SPAP payments count toward that cap, meaning SPAP members often reach catastrophic coverage faster and pay nothing out of pocket for the rest of the year.
Coverage Breakdown
| State Program | Age/Disability | Income Limit (Single) | Income Limit (Couple) | What It Covers |
|---|---|---|---|---|
| NY EPIC (Elderly Pharmaceutical Insurance Coverage) | Age 65+ | Up to $75,000/year | Up to $100,000/year | Part D premiums (up to $23K income) + copay reduction; 2-tier Fee/Deductible plan |
| NJ PAAD (Pharmaceutical Assistance to the Aged and Disabled) | Age 65+ or disabled | Under $54,943/year | Under $62,390/year | Copays capped at $5 generic / $7 brand; Part D premium assistance |
| NJ Senior Gold Prescription Discount | Age 65+ | $54,943 to $64,943/year | $62,390 to $72,390/year | Discounts on any drug copay over $15; accelerates Part D catastrophic coverage |
| PA PACE (Pharmaceutical Assistance Contract for the Elderly) | Age 65+ | Up to $14,500/year | Up to $17,700/year | Low copays on covered drugs; wraps around Part D |
| PA PACENET (higher-income tier of PACE) | Age 65+ | $14,501 to $45,000/year (as of July 2026) | $17,701 to $55,000/year (as of July 2026) | Annual deductible then copay assistance; Part D coordination |
| MA Prescription Advantage | Age 65+ or disabled | Up to 500% FPL (~$79,800/year single) | Up to 500% FPL (~$108,200/year couple) | Copay and premium assistance scaled to income; no asset test |
| MD SPDAP (Senior Prescription Drug Assistance Program) | Age 65+ | Up to 300% FPL (~$47,880/year single) | Up to 300% FPL (~$64,920/year couple) | Up to $100/month premium subsidy; no coverage gap subsidy for 2026 |
| WI SeniorCare | Age 65+ | 4 tiers up to 240% FPL (~$38,304/year single) | 4 tiers up to 240% FPL (~$51,936/year couple) | $5/$15 copays at lowest tier; $30/year enrollment fee; alternative to Part D |
| VT VPharm | Age 65+ or disabled | Up to 225% FPL (~$2,991/month single; 3 income tiers) | Up to 225% FPL (~$4,060/month couple; 3 income tiers) | Monthly premiums of $15, $20, or $50 based on income; prescription cost-share reduction |
Income limits shown are annual gross income. Some programs use prior-year income. PACENET income limits increase effective July 1, 2026 under newly enacted Pennsylvania legislation. 500% FPL figures for MA based on 2026 HHS guidelines for a 1- and 2-person household.
Source: NY Dept of Health EPIC 2026, NJ Div of Aging Services, PA Dept of Aging, Mass.gov Prescription Advantage, Maryland SPDAP, WI DHS SeniorCare, VT Agency of Human Services
How SPAPs Work With Medicare Part D in 2026
SPAPs are secondary payers to Medicare Part D. When you fill a prescription, Part D pays first. Your SPAP then covers some or all of your remaining cost-share, depending on your program's benefit design. The key mechanical detail: SPAP payments count toward your TrOOP (True Out-of-Pocket) total under Part D. The 2026 Part D out-of-pocket cap is $2,100. Because SPAP contributions accelerate your TrOOP, members often reach the catastrophic phase earlier in the calendar year and pay $0 out of pocket after that.
CMS exchanges data files with SPAPs to coordinate benefits and calculate TrOOP correctly. Pharmacies in states with active SPAPs are connected to this coordination system. You do not need to manually submit claims: present both your Part D card and your SPAP card at the counter and the pharmacy handles the rest.
- Most SPAPs require you to be enrolled in a Part D plan as a prerequisite. Wisconsin SeniorCare is one exception: it can serve as an alternative to Part D for members who choose not to enroll in a standard Part D plan.
- SPAPs are considered creditable coverage for Part D purposes. If your SPAP is your only drug coverage and it counts as creditable, you will not face a late enrollment penalty when you later join a Part D plan.
- The 2026 Part D $35/month insulin cap applies regardless of SPAP status. SPAP members also benefit from this IRA-mandated cap.
Can You Get Both SPAP and Extra Help (LIS)?
Yes. SPAPs and Medicare Part D Extra Help (also called the Low-Income Subsidy, or LIS) are separate programs and you can receive both at the same time. Extra Help is a federal program administered by the Social Security Administration that covers Part D premiums, deductibles, and copays for individuals with income at or below 150% of the Federal Poverty Level ($23,940/year for a single person in 2026). In 2026, everyone who qualifies for Extra Help receives full benefits, with copays capped at $5.10 for generics and $12.65 for brand-name drugs.
If you already receive Extra Help, your state SPAP can still help with remaining costs that Extra Help does not fully eliminate, or can pay your Part D premium if Extra Help does not cover your specific plan's premium in full. NY EPIC, for example, explicitly coordinates with both Extra Help and standard Part D plans. NJ PAAD also layers on top of any Extra Help benefit you already receive.
States Without an Active SPAP in 2026: What To Do
If you live in a state that does not have an active SPAP in 2026, you have several alternative pathways to reduce prescription drug costs. The IRA's $2,100 Part D out-of-pocket cap, effective in 2026, already eliminates the old coverage gap (donut hole) for all Part D enrollees. Beyond that:
- Apply for Medicare Part D Extra Help (LIS) through SSA at ssa.gov/medicare/part-d-extra-help if your income is at or below 150% FPL. This is available in every state.
- Apply for a Medicare Savings Program (MSP) through your state Medicaid office. MSPs cover Part B premiums and may cover Part D costs if you are dual-eligible.
- Check manufacturer patient assistance programs. Most brand-name drug manufacturers offer PAPs for low-income Medicare beneficiaries, often covering $0 cost shares for specific medications.
- Use GoodRx, NeedyMeds, or other prescription discount programs at participating pharmacies. These cannot be used simultaneously with Part D, but can be cheaper for certain drugs if you pay cash.
- Request the $35/month insulin cap that the IRA mandates for all Part D plans. All 2026 Part D plans must cap insulin at $35 per month per covered insulin product.