What Is PAAD?
- PAAD provides coverage for prescribed legend drugs, insulin and insulin supplies.
- The PAAD co-payment will be $5 for each PAAD covered generic drug prescription and $7 for each PAAD covered brand name drug prescription. PAAD beneficiaries may pay less for generic drugs if their Medicare prescription drug plan charges them less than the $5 PAAD co-payment for generics.
- PAAD does not pay for diabetic testing supplies (e.g., test strips and lancets). If PAAD beneficiaries have health insurance coverage, such as Medicare Part B that pays for diabetic testing supplies a pharmacy must bill that insurance plan. PAAD will not pay for them.
- A PAAD beneficiary must be a New Jersey resident;
- A PAAD beneficiary must be 65 years of age or older, or at least 18 years of age and receiving Social Security Title II Disability benefits; and
- A PAAD beneficiary must have annual income for 2018 of less than $27,189 if single or less than $33,334 if married;
- PAAD beneficiaries are also required to enroll in a Medicare Part D Prescription Drug Plan. State and/or federal governments will pay Medicare Part D premiums for certain standard 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 premium for certain standard basic Medicare Part D plans or enhanced Part D plans with monthly premiums up to $20 over the regional benchmark that have no deductibles. Medicare Advantage(MA) participants must add a prescription benefit to their coverage, and 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 a former employer or union. To find out which basic Part D plans in New Jersey for which PAAD pays the monthly premium, please call 1-800-792-9745.
- For additional information call toll free Hotline 1-800-792-9745.
All PAAD participants, if they are eligible for Medicare Part A or enrolled in Medicare Part B, must enroll in a Medicare Part D Prescription Drug Plan. All PAAD applicants must also submit information to PAAD to help determine if they may be eligible for "Extra Help" from the federal government to help pay for Medicare Part D. Medicare eligible PAAD participants will use PAAD benefits together with Medicare Part D benefits. If a Medicare Part D plan is the primary payer for a medication covered on its formulary, PAAD will provide coverage as secondary payer if needed for that drug, and the PAAD beneficiary will 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, PAAD beneficiaries will have to switch to a drug on the Part D plan's formulary, or their doctor will have to request an exception due to medical necessity directly to their Part D plan.
A husband and wife must file separate applications. Once PAAD has determined your eligibility, you should receive an identification card within 30 days. With your PAAD card, you pay the pharmacist no more than $5 for each PAAD covered generic drug or $7 for each PAAD covered brand name drug.
By signing the Universal Application (UA-1), you are authorizing the State of New Jersey to collect payments made on your behalf from any other assistance program, insurance or retirement benefits which may cover prescription drugs.
If you have health insurance or retirement benefits that provide prescription coverage equal to or better than PAAD, or if you are receiving Medicaid, you would NOT be eligible. However, you are eligible if your health insurance or retirement plan offers limited or partial coverage.
Some PAAD beneficiaries must reapply every year, although most beneficiaries must only submit a renewal application every two years.
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.
The PAAD and Senior Gold programs are required by law to provide generic substitutions for brand name drugs that have approved generics available. Generic drugs are less costly substitutes with the same active ingredients as drugs sold under a brand name. In order for a PAAD or Senior Gold cardholder to receive the brand name version instead of the approved generic when PAAD or Senior Gold is the primary payer for a prescription, the prescribing physician must request Prior Authorization. However, certain 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 100 unit doses, whichever is greater. This regulation prevents the waste of medication should the initial prescription prove to be inappropriate to the beneficiary and allows persons on maintenance drugs to receive up to 100 unit does for subsequent refills.
The State of New Jersey has established an enhanced Drug Utilization Review (DUR) component for the PAAD program to safeguard against harmful drug / drug interactions, doses that are too small to too large, over-extended drug therapy or drug duplication. This will not prevent beneficiaries from obtaining medicine that your doctor believes to be medically necessary.
Information Provided By New Jersey Department Of Human Services