State Pharmacy Assistance Programs (SPAP)

Reallocation of State contributions to an ADAP to a State Pharmacy Assistance Program (SPAP) so that Medicare cost-sharing payments made on behalf of clients will count toward TrOOP.
State funds allocated to an ADAP in order to meet the State’s Part B or ADAP matching requirement may NOT be redirected to another program.

ADAP funds used to make Part D prescription drug benefit cost-sharing payments on behalf of clients will not count towards TrOOP. This rule applies, regardless of whether ADAP dollars are used directly or indirectly through an SPAP or charitable organization.

A State could use State-only dollars historically used to support ADAP in order to establish a qualified SPAP to cover Part D beneficiary costs for low-income Medicare beneficiaries living with HIV/AIDS, but this would have to be done at the State appropriations level. In addition, States must continue to comply with the Ryan White maintenance-of-effort (MoE) requirement. To be MoE compliant, the State must be able to document that the amount of funds historically appropriated for ADAP are used to pay Medicare beneficiary costs only for people living with HIV/AIDS. Grantees are reminded that the MoE requirement is a condition-of-award and subject to audit, and therefore requires States to maintain appropriate records. Also, if a State chooses to do this, the State may not use those State funds in order to qualify for ADAP funding AND act as a SPAP.

Creation of new groups by SPAPs to meet the Part D cost-sharing requirements of Medicare Part D. A: Yes.