If you cannot afford to pay for your prescription drugs, New Jersey’s PAAD program may be able to help you.
Is this you?
If you meet this description, you should be eligible for the PAAD program and pay no more than $5 for each covered generic prescription and $7 for each covered brand-name prescription.
You do not have to be a U.S. citizen or lawful permanent resident to be eligible for PAAD.
What drugs does PAAD cover?
PAAD provides coverage for prescribed legend drugs, insulin and insulin supplies and syringes and needles for injectable medicines used for the treatment of multiple sclerosis. PAAD does not pay for diabetic testing supplies (e.g., test strips and lancets) and Medicare Part D excluded drugs except benzodiazepines and barbiturates.
Only drugs approved by the Food and Drug Administration are covered. Drugs purchased outside the State of New Jersey are not covered, nor is any pharmaceutical product whose manufacturer has not agreed to provide rebates to the State of New Jersey.
The PAAD program is required to provide generic substitutions for brand name drugs for which there are approved generics available. In order for you to receive the brand name version instead of the approved generic when PAAD is the primary payer for a prescription, the prescribing physician must request Prior Authorization. (Note that a few brand name drugs with a narrow therapeutic index or a lower cost per unit than the generic may be excluded from the Prior Authorization process.)
Initial prescriptions are limited to a 34-day supply when PAAD is the primary payer. Subsequent refills may be dispensed up to a 34-day supply or in 100-unit doses, whichever is greater.
What about Medicare Part D?
All PAAD applicants must submit financial information in order to determine if they are eligible for "Extra Help" from the federal government to pay for Medicare Part D.
PAAD beneficiaries who are also Medicare beneficiaries are required to enroll in a Medicare Part D Prescription Drug Plan. State and/or federal governments will pay Medicare Part D premiums for certain basic Medicare Part D plans with a monthly premium at or below the regional benchmark. In addition, the State of New Jersey will pay Medicare Part D premiums for certain basic Medicare Part D plans with monthly premiums up to $5 over the regional benchmark that have no deductibles. (To find out which basic Part D plans in New Jersey for which PAAD pays the monthly premium, call 1-800-792-9745.)
If you are a Medicare Advantage (MA) participant you must add a prescription benefit to their coverage. PAAD will contribute up to the regional benchmark amount towards the prescription portion of the total premium for New Jersey plans, unless the MA plan is paid for by your former employer or union.
You will still only pay a maximum of only $5 or $7 per prescription as described above. You may pay even less for generic drugs if your Medicare prescription drug plan charges them less than the $5 PAAD co-payment for generics.
Medicare-eligible PAAD participants use PAAD benefits together with Medicare Part D benefits. If your Medicare Part D plan is the primary payer for a medication covered on its formulary, PAAD will provide coverage as the secondary payer (if needed) for that drug, and you will only pay up to the regular PAAD copayment for PAAD covered drugs. However, if a Medicare Part D plan does not pay for a medication because the drug is not on its “formulary”, you will either have to switch to a drug that is on your Part D plan's formulary, or have the prescribing doctor make a request for an exception due to medical necessity directly to your Part D plan.
How do I apply? How do I renew?
New Jersey’s Department of Health and Senior Services has developed a universal application to screen applicants for several federal and state programs that provide assistance with the costs of health care for low-income residents.
You may also call PAAD at 1-800-792-9745 to receive an application by mail and for more information.
Most beneficiaries renew their PAAD eligibility every two years, although some PAAD beneficiaries must reapply every year. Approximately four months before your PAAD card expires, you should receive a PAAD renewal form. Complete this form and return it by mail. Call the PAAD toll-free number (1-800-792-9745) if you have not received a renewal form at least two months before your card expires.
This information last reviewed: Jun 26, 2012