Prescription Advantage FAQ
This information has been provided by the Massachusetts Executive Office of Aging & Independence (AGE).
Q: Why is Prescription Advantage being phased out?
- Prescription Advantage is being gradually phased out, and is closing effective July 2027, because the Medicare coverage gap it was designed to address has largely been eliminated.
- The program was established in the early 2000’s to protect older adults from paying high out-of-pocket drug costs that were not covered by Medicare Part D. This gap in coverage was commonly known as the “donut hole”. At the end of the program’s first year, there were over 75,000 members.
- Now, 25 years later, federal changes to Medicare have effectively eliminated this gap, and expanded eligibility for other assistance programs has further reduced the need for Prescription Advantage. Today, there are only 75 members enrolled in the program, and less than 10 receive a financial benefit. As a result, AGE is beginning a planned wind-down of the program.
Q: What changes are taking place with Prescription Advantage?
- Prescription Advantage will stop accepting new applications effective June 30, 2026.
- No one currently enrolled in Prescription Advantage will lose benefits during 2026.
- Members who currently receive benefits will begin to transition from a point-of-sale model to a reimbursement process.
- AGE will work directly with affected members to ensure they are connected to available resources and supports.
Q: Why are you no longer accepting applications?
- The state is beginning to wind down the program. Demand for Prescription Advantage has declined significantly due to federal Medicare changes and expanded eligibility for other assistance programs.
- This decision reflects the reality that the program has fulfilled the purpose for which it was created. As healthcare coverage has evolved, the need for this standalone state program has diminished significantly.
Q: Will you be accepting applications again in the future?
- AGE does not anticipate reopening enrollment because the original need for the program has largely been addressed through changes in Medicare coverage and other available supports.
Q: I currently have Prescription Advantage, but I heard you are no longer accepting applications. Am I in danger of losing my benefits?
- Current consumers will continue receiving support during the transition period and will be connected to alternative resources before the program closes.
Q: How will existing consumers be impacted?
- Existing consumers will transition from a point-of-sale process to a consumer reimbursement process.
- Consumers will be sent a formal notice in November connecting them to individualized assistance.
Q: Are these changes related to budget cuts?
- These changes are part of AGE’s ongoing efforts to align resources with current needs and ensure programs are operating effectively. Prescription Advantage served an important purpose, but due to the recent Medicare coverage changes, the need for the program has been significantly reduced.
Q: What will AGE do with the Prescription Advantage funding?
- AGE will redirect available resources toward programs and services that support the broader and evolving needs of older adults across the Commonwealth. This will allow the agency to invest in programs that serve more consumers and have greater overall impact.
Q: What alternative supports are available for non-Medicare members?
- We will connect members to MassOptions enrollment assistance resources, specialized pharmaceutical company subsidy programs, and other resources including Health Care For All Help Line.
Q: On average, how much will a Prescription Advantage member have to pay out of pocket once the program ends?
- For the majority of current Prescription Advantage members, there will be no impact as they are also Medicare members and receive no financial benefit from Prescription Advantage.
- For the 75 non-Medicare members, they will be responsible for their out-of-pocket prescription costs. Please note that at this point in time, only 8 of them are receiving benefits. We are currently exploring potential options for alternative ways to support these members after Prescription Advantage closes.
Q: Who are the 75 people impacted by the program’s closure?
- Current claims are connected to residents who are not Medicare members. They are mostly not eligible for Medicare (e.g., immigration status, self-employed). A few may need support applying for Medicare.
- No one currently enrolled in the program will lose benefits during FY27. AGE will connect with all 75 current members, with a priority on the 8 currently receiving benefits, to ensure they are connected to alternative resources.
Q: When is the last day PA will accept applications?
- June 30, 2026