Cost-Sharing Provisions by State and Program, 2003 (Part 3)

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Presentation transcript:

Cost-Sharing Provisions by State and Program, 2003 (Part 3) State (Program) Income Eligibility (% FPL) Annual Fee/ Premium Deductible Coinsurance/Copay Benefit Cap Out of Pocket Cap PA (PACE) 156% $6 PA (PACENET) 178% $500 a year $8 generic, $15 brand RI 420% 40%, 70%, or 85% by income $1,500 for lowest income level SC 200% $10 generic, $15 brand, $21 brand name requiring prior authorization VT (VHAP) 150% $3 generic, $6 brand $50 per calendar quarter VT (VScript) 175% $5 generic, $10 brand $100 per calendar quarter VT (VScript Exp.) 225% $275 a year 41% $2,500 per calendar quarter WI 240% Income<160% FPL – no deductible; income 160%<200% FPL - $500 deductible per person; income 200%<240% FPL - $850 per person; income >240% FPL - $850 after spend down $5 generic, $15 brand WY 100% $10 generic, $25 brand 3 prescriptions per month