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Senate of Pennsylvania
Session of 2021 - 2022 Regular Session


Posted: April 8, 2021 04:13 PM
From: Senator Judy Ward and Sen. Maria Collett
To: All Senate members
Subject: PACENET Expansion
Please join us in co-sponsoring this legislation, which aims to make several important changes to the PACENET program to better support our seniors in need of prescription assistance.
The PACE/PACENET program serves more than 275,000 low-income older adults each year, providing low-cost prescription medication assistance and supplementing other prescription drug programs, such as Medicare Part D, employer plans, and veteran’s benefits. This legislation aims to make several improvements to the PACENET program in order to serve more of our older Pennsylvanians who would benefit from the program.
The first proposed change would be to eliminate what is known as the PACENET premium “clawback”. Currently, PACENET cardholders pay a copay for each claim along with either a monthly benchmark premium or a monthly Part D plan premium. The PACE program pays for the upfront premium costs but recoups these costs at the point of sale during each subsequent claim. This practice is known as the PACENET premium clawback. This can cause confusion for the cardholder, the pharmacy, and other entities such as the PACE call center or our own legislative district offices, as cardholders with infrequent claims may experience large cost “spikes” at the point of sale.
The elimination of this clawback would be made possible through the second proposed change, which would permit the PACE program to enroll a PACENET cardholder in a Medicare Part D plan when it benefits the cardholder. Savings achieved by shifting claims costs to a Medicare Part D plan would allow the Department of Aging to absorb the cost of removing the PACENET premium clawback.
Finally, this legislation would expand the income eligibility for the PACENET program from $27,500 to $33,500 for single individuals and from $35,500 to $41,500 for married couples. The anticipated savings from enrolling eligible PACENET individuals in Medicare Part D plans will provide enough savings to also cover the cost of this proposed income expansion. It is estimated that the increase in income eligibility will result in nearly 19,000 new enrollees.   
We hope you will join us in cosponsoring this legislation.

Introduced as SB668