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Vermont State Pharmacy Assistance Programs (SPAP)

VPharm,
Vermont Health Access Plan (VHAP-Pharmacy),
VSCRIPT Expanded and
Vermont VPHARM



:: VPharm
:: Vermont Health Access Plan (VHAP-Pharmacy)
:: VSCRIPT Expanded
:: Vermont VPHARM

VPharm


VPharm Eligibility Requirements: You must meet the following requirements:
  • You must be a Vermont state resident and U.S. citizen or resident alien who is lawfully admitted.
  • You must be 65 years of age or receiving disability benefits from Social Security.
  • You can't have other prescription drug coverage with the exception of Medicare.
  • You have an income less than 150%-VPharm 1, 175%-VPharm 2 and 225%-VPharm 3.
Important Notes: VPharm 1 - Members on VPharm 1 pay a monthly premium. In return, VPharm 1 pays for:
  • The amount of your PDP premium that LIS does not pay for, up to a maximum amount.
  • PDP copays, deductibles, co-insurance and coverage gaps not covered by LIS, for shortterm and long-term drugs covered by the PDP.
  • Specific types of drugs that are not covered by the PDP, but are covered by Vermont (drugs for anorexia, weight gain, or weight loss; certain vitamins; some over-the- counter medicine, barbiturates; or benzodiazepines), and
  • One comprehensive eye exam and one interim exam every two years by an optometrist or an ophthalmologist.
VPharm 2 - Members on VPharm 2 pay a monthly premium. In return, VPharm 2 pays for:
  • The amount of your PDP premium that LIS does not pay for, up to a maximum amount.
  • PDP copays, deductibles, co-insurance and coverage gaps not covered by LIS for drugs covered by the PDP that are used to treat long-term medical problems, and
  • Specific types of drugs used to treat long-term medical problems that are not covered by the PDP, but are covered by Vermont (drugs for anorexia, weight gain, or weight loss; certain vitamins; some over-the-counter medicine, barbiturates; or benzodiazepines). The Healthy Vermonters Program may also give you a discount on some of the drugs not covered by VPharm 2 that are used to treat short-term medical problems. As a VPharm 2 member you do not need to apply for the Healthy Vermonters Program, you will receive the discount automatically.
VPharm 3 - Members on VPharm 3 pay a monthly premium. In return, VPharm 3 pays for:
  • The amount of your PDP premium that LIS does not pay for, up to a maximum amount.
  • PDP copays, deductibles, co-insurance and coverage gaps not covered by LIS for drugs covered by the PDP and Vermont that are used to treat long-term medical problems, and have a rebate agreement with the state of Vermont.
  • Specific types of drugs used to treat long-term medical problems that are not covered by the PDP but are covered by Vermont (drugs for anorexia, weight gain, or weight loss; certain vitamins; some over-the-counter medicine, barbiturates; or benzodiazepines).
Co-Pays - If you are on VPharm 1, 2, or 3, you will have a co-pay of $1 or $2.
  • If the cost to the state for your prescription is $29.99 or less, your co-pay will be $1.00.
  • If the state ’s cost is $30.00 or more, your co-pay will be $2.00.
Premiums - VPharm 1, 2, and 3 monthly premiums are $15, $20 or $50 depending on income.
Contact Information: Phone
(800) 250-8427

Address
VPharm
312 Hurricane Lane, Suite 201
Williston, VT 05495
: : VPharm

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Vermont Health Access Plan (VHAP-Pharmacy)


VHAP-Pharmacy Eligibility Requirements: VHAP - Pharmacy ended March 31, 2014
Important Notes: Vermonters who previously had Catamount or VHAP there are some changes to their coverage options. Some Vermonters with Catamount or VHAP are eligible for low cost or free health coverage through Medicaid as a result of a Medicaid expansion. Others with higher incomes are using Vermont Health Connect to purchase health insurance with the help of tax credits and other forms of financial assistance to help cover the cost of their care. Notices were mailed to Catamount and VHAP members during summer and fall 2013 to let them know which group they were in and what, if any, action was required.
Contact Information: Phone
(800) 250-8427
(802) 879-5900


: : Vermont Health Access Plan (VHAP-Pharmacy) - Ended

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VSCRIPT Expanded


VScript Expanded Eligibility Requirements: VScript Expanded - Program ended January 1, 2014. If already enrolled you will have coverage until March 31, 2014.
Important Notes: Catamount, VHAP and VScrip Programs are ending. In 2014, members will access health coverage through Vermont Health Connect. If you have questions, call 1-800-250-8427.

If you currently have Catamount, VHAP or VScript:

You should have received a notice in the mail last fall informing you, depending on your income, that:
  • Your coverage would automatically be extended until you select a Qualified Health Plan (QHP) through VermontHealthConnect, though no later than March 2014. To avoid gaps in coverage, apply for a new plan any time before March 15, 2014.
-OR-
  • You would be automatically enrolled in Vermont Medicaid beginning January 1, 2014.
If you do not currently have Catamount or VHAP and need coverage:

Apply for a Qualified Health Plan (QHP) at VermontHealthConnect or call toll-free 1-855-899-9600.
Contact Information: Phone
(800) 250-8427

Address
VSCRIPT Expanded
DCF -Economic Services Division
Application and Document Processing Center 103 South Main Street
Waterbury , VT 05671
: : Vermont VSCRIPT Expanded



Vermont VPHARM


Vermont VPHARM Eligibility Requirements: You must meet the following requirements:
  • You must be a Vermont state resident and U.S. citizen or resident alien who is lawfully admitted.
  • Your annual income must not exceed $22,164 for one person or $29,820 for a couple.
  • You must be 65 years of age or receiving disability benefits from Social Security and not be eligible for Medicare.
  • You can’t have other prescription drug coverage.
Important Notes: VPharm assists Vermonters who are enrolled in Medicare Part D with paying for prescription medicines. This includes people age 65 and older as well as people of all ages with disabilities and includes an affordable monthly premium.

After participants pay a $20 monthly premium, patient is responsible for $1 or $2, depending on the cost of the drug.

Call 802-879-5900 for additional information.
Contact Information: Phone
(800) 250-8427

Address
Vermont VPHARM
3 North 103 South Main Street
Waterbury, VT 05676
: : Vermont VPHARM

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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.


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