State Drug Assistance Programs That Can Lower Your Prescription Costs

Medicare Extra Help (also called the Low-Income Subsidy or LIS) is a federal program administered by the Social Security Administration and available in all 50 states. It helps pay Medicare Part D premiums, deductibles, and copays for seniors with income below 150% of the Federal Poverty Level (roughly $24,180 for a single person in 2026). It is worth an average of $5,700 per year per enrollee.

SPAPs (State Pharmaceutical Assistance Programs) are run by individual states and typically have higher income limits than Extra Help. They fill in gaps Extra Help does not cover — for example, New York's EPIC accepts income up to $75,000 per year, far above Extra Help's cutoff. SPAPs and Extra Help can be stacked together for maximum savings. For example, in New York, EPIC and Extra Help can together pay up to $117.64 per month toward your Part D premium.

Yes — and there are multiple paths. First, apply for Medicare Extra Help through the Social Security Administration. This is available in all 50 states and worth an average of $5,700 per year. Second, use BenefitsCheckUp.org (free, from the National Council on Aging) to search your ZIP code for any state-level discount programs, utility assistance programs, or other benefits you may qualify for. Third, over 180 pharmaceutical manufacturers sponsor Patient Assistance Programs (PAPs) providing free or heavily discounted brand-name drugs to qualifying patients — often up to 400% of the Federal Poverty Level. Search by drug name at needymeds.org or rxassist.org to find PAPs for your specific medications.

Most SPAPs have no asset test at all. New Jersey PAAD, New York EPIC, Pennsylvania PACE/PACENET, Rhode Island RIPAE, and Maryland SPDAP all determine eligibility based solely on your annual income — not on what you own. This is a crucial difference from Medicaid, which does count assets. If your income is within the program limits, you qualify regardless of whether you own a paid-off home, a car, or have savings in the bank.

Medicare Extra Help does have an asset limit ($17,600 for individuals / $35,130 for couples in 2026), but it excludes your home, one vehicle, and life insurance policies with face value under $1,500. Apply even if you think you might be over the asset limit — many items are excluded from the count.

Most SPAPs use your prior calendar year's income — the same figure reported on your federal income tax return. For 2026 program eligibility, programs typically look at 2025 income. This is important because: if your income dropped recently (due to retirement, a spouse's death, or reduced work hours), your current income may be lower than last year's. You may be ineligible now but become eligible when the new year's income is reviewed.

Note that most programs exclude Medicare Part B premiums when calculating income, which effectively raises the ceiling slightly. For example, if you pay $185/month in Part B premiums, that $2,220 per year is subtracted from your gross income when determining PACE eligibility. Always call the program hotline to confirm which income sources are and are not counted.

For most SPAPs, yes — Medicare Part D enrollment is required. New Jersey PAAD, New York EPIC, Rhode Island RIPAE, Maryland SPDAP, and Delaware DPAP all require that you have an active Part D prescription drug plan before they will pay benefits. These programs are designed to work as secondary coverage on top of Part D.

The exception is Pennsylvania PACE, which is the only major SPAP that does not require Part D enrollment. PACE will cover your prescriptions directly, though PACENET members who skip Part D are charged a monthly premium equal to the regional benchmark ($32.71 in 2026).

The good news: enrolling in a qualifying SPAP typically grants you a Medicare Special Enrollment Period (SEP), allowing you to join or switch a Part D plan at any time during the year rather than waiting for annual enrollment.

Renewal schedules vary by program. New Jersey PAAD requires renewal most enrollees every two years; however, some beneficiaries must renew annually depending on their circumstances. New York EPIC is renewed annually based on your prior-year income. Pennsylvania PACE/PACENET eligibility is also determined annually using the prior calendar year's income.

Watch your mail each fall for renewal notices. If your income changes significantly — for example, due to a Social Security COLA increase — report changes promptly. Pennsylvania specifically enacted COLA protection legislation in 2026 to prevent PACE/PACENET enrollees from losing eligibility solely because of Social Security annual adjustments. Extra Help from Medicare is reviewed by SSA periodically and you may receive a notice to reapply.

Starting in 2025 and continuing in 2026, Medicare Part D has a $2,100 annual out-of-pocket cap. Once your total drug costs (including what your plan pays) reach $2,100, you enter catastrophic coverage and pay $0 for covered drugs for the rest of the year. This cap is a major improvement over the old “donut hole” system.

If you are enrolled in both a SPAP and Medicare Part D, the amounts your SPAP pays can count toward your $2,100 cap, helping you reach the zero-cost catastrophic phase much faster — sometimes as early as February or March if you take expensive medications. This is one of the most financially significant reasons to enroll in both Extra Help and a SPAP simultaneously if you qualify.

Yes. In addition to general SPAPs, several targeted programs exist. AIDS Drug Assistance Programs (ADAPs) operate in every state and provide HIV/AIDS medications to eligible individuals regardless of insurance status, with income limits often up to 400% of the Federal Poverty Level. Chronic Renal Disease programs in states like Delaware and Maryland help pay unreimbursed costs related to end-stage kidney disease. State mental health pharmaceutical programs in some states cover specific psychiatric medications for low-income residents.

For high-cost brand-name drugs such as biologics, cancer medications, or specialty drugs, manufacturer Patient Assistance Programs (PAPs) often offer free medications directly from the pharmaceutical company. Over 180 companies offer PAPs covering more than 2,500 brand-name drugs. Search by drug name at NeedyMeds.org or RxAssist.org to find assistance for your specific medication.