Prescription Advantage Program

Massachusetts

Prescription Advantage is a prescription drug insurance plan available to all Massachusetts residents age 65 and older, as well as younger individuals with disabilities who meet income and employment guidelines.
Contact Information
Prescription Advantage
P.O. Box 15153
Worcester, MA 01615-0153
1-(800) 243-4636 (phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
  • Click here to visit the program's web site.
  • Eligibility:
    Who Can Join: You may join Prescription Advantage if you are a Massachusetts resident and you are: 1. Age 65 or older; or Under age 65, work 40 hours or fewer per month, or not at all, and meet income and disability guidelines. Individuals receiving prescription drug benefits through Medicaid (MassHealth or CommonHealth) cannot join Prescription Advantage. When You Can Join: For those age 65 to 66: You may join at any time before your 66th birthday. If you submit your application up to three months before you turn 65, the Plan will hold your application and process it as of your 65th birthday. Your benefits will begin on the first day of the month following the complete processing of your application. If you choose not to join during this period, you will have to wait until the next open enrollment period. For those age 66 or older: You may join Prescription Advantage only during an established open enrollment period, unless you qualify for an exception (see below). The next open enrollment period is September 1 through September 30, 2004, for benefits beginning on or after November 1, depending on when your complete application is received. If you choose not to join during this period, you will have to wait for the next open enrollment period. Exceptions for individuals age 66 or older: Those who meet one of the following conditions will be granted an exception to the rules above: Recently moved to Massachusetts; or Involuntarily lost health care coverage; or Recently became ineligible for Medicaid (MassHealth). If any of these circumstances apply to you, you have up to six months from the date that the circumstance occurred to submit an application. Your benefits will begin on the first day of the month following the complete processing of your application. For those under age 65: You may join at any time, however, you must work 40 hours or fewer per month, or not at all, and meet disability and income guidelines. Your benefits will begin on the first day of the month following the complete processing of your application. Please note: All deadlines are determined by the date the Plan receives your application, NOT when it is post-marked. You should allow at least five business days and include the appropriate amount of additional postage for first class mail to arrive.
    Other Information:
    Prescription Advantage is a prescription drug insurance plan administered by the Commonwealth of Massachusetts Executive Office of Elder Affairs. Prescription Advantage is available to all Massachusetts residents age 65 or older, as well as younger individuals with disabilities who meet income and employment guidelines. Prescription Advantage members pay premiums, deductibles and co-payments based on their gross annual household income. The Rate Schedule Guide on page 3 lists premium, deductible and co-payment rates for Prescription Advantage effective July 1, 2004. Prescription Advantage, unlike many other plans, places an annual out-of-pocket spending limit on the amount you pay toward your prescription drugs in deductible and co-payment amounts. Your annual out-of-pocket spending limit is based on your gross annual household income. The Rate Schedule Guide on page 3 lists the annual out-of-pocket spending limits for Prescription Advantage effective July 1, 2004. Prescription Advantage covers most outpatient prescription drugs, including insulin and disposable insulin syringes with needles. The drugs on the formulary (the list of drugs available to members) are categorized into three levels: generic, brand-name drugs and additional brand-name drugs. Generic drugs have the lowest co-payment; additional brand-name drugs have the highest co-payment.