PACE / PACENET PROGRAM
On January 1, 2004, new
PACE/PACENET legislation becomes effective.
PACE recognizes that many
providers assist cardholders in answering PACE or PACENET questions. The
following is a brief overview of how the new legislation affects both potential
and current cardholders.
PACE Single applicant - Increased to $14,500 PACENET Single - Increased to $23,500
Married applicant - Increased to
$17,700 PACENET Married - Increased to
Generics PACE - $6.00;
PACENET - $8.00
Single-source / Brand PACE - $9.00; PACENET - $15.00
When a drug has an A-rated generic, PACE/PACENET requires
the use of the generic. Claims for “brand” name products having an A-rated
generic will be denied unless a medical exception is approved by
“generic differential” calculation (entry of DAW code “2” or “4”) is
discontinued effective January 1, 2004.
cardholders will be responsible for the entire cost of their prescription
if they insist on the brand name product in the absence of a medical
exception. (DAW 2)
providers will be responsible for the U&C minus the copay if the
brand name product is dispensed for the generic because the product is
not in stock (DAW 4).
cardholders must pay a $40.00 monthly cumulative deductible based
on the cardholder’s ENROLLMENT month.
Example: Cardholder enrolls with an effective
date January 1, 2004; does not use PACENET benefit until March 1. A deductible
of $120.00 ($40 X 3 months) must be
paid before the PACENET reimbursement.
PACENET claims are subject to PACE edits.
deductible PACENET claims are not included in the monthly
denied solely for being over-income have had their applications
reprocessed by PACE and sent their PACE or PACENET card. These new
cardholders’ eligibility becomes effective January 1, 2004.
denied for being over-income, but had other documents missing have been
sent letters informing them of the necessary documents to enroll in the
encourage potential applicants to apply, the Program is accepting income
documents from 2002 until March 31, 2004.
may obtain enrollment forms from providers, legislative offices, Area
Agency on Aging offices or the Department’s website at www.aging.state.pa.us .
questions can be answered by calling 1-800-225-7223.