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Briefings by DHFS for the Assembly Committee on Medicaid Reform
SeniorCare and Medicare Part D Definitions
PDF (55 KB)
- AWP — Average wholesale price (used for most single source
brand drugs)
- Donut hole — Recipient drug expenditures between $2,250 and $5,100
per year which are not covered under Medicare Part D.
- Dual eligible — Individuals who are eligible for both Medicaid and
Medicare.
- Elderly Benefit Specialist Program — The Elderly Benefit Specialist
program is a state program designed to assist older persons gain access to
private or governmental benefits. County/tribal benefit specialists, who are
trained and supervised by regional attorneys specializing in elder law and
benefits, help older persons determine what benefits they are entitled to,
tell them what they must do to receive the benefits and assist with paperwork.
- LIS — Low income subsidy which provides extra help with the
Medicare Part D cost sharing requirements.
- MAC — Maximum allowed cost (used for multi-source, generic
drugs)
- PA — Prior authorization
- PDL — Preferred drug list
- PDP — Prescription drug plan
- Pharmacy Plus Demonstration Initiative — Under a Section 1115
pharmacy demonstration, states could request a waiver from CMS to provide
prescription drug coverage to a range of individuals including Medicare
beneficiaries and/or people with disabilities who are not eligible for full
Medicaid benefits under title XIX of the Social Security Act and with incomes
at or below 200 percent of the Federal Poverty Level (FPL).
- SPAP — State pharmacy assistance program
- SSA — Social Security Administration
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