2024 Changes to the NJ PAAD and Senior Gold programs: GSK and Eli Lily Participation

The NJ Department of Human Services recently announced that two additional pharmaceutical manufacturers would not allow its medications to be discounted for New Jersey recipients of the Pharmaceutical Assistance to the Aged and Disabled (PAAD) or Senior Gold programs.  These manufacturers are GlaxoSmithKline (GSK) and Eli Lilly, and they follow Novo Nordisk, who ended their participation in the programs in 2023.

What is NJ PAAD and Senior Gold?

The NJ PAAD and Senior Gold program help Medicare recipients on a limited income in the state of New Jersey afford their medications.  The state recently announced that in 2024, they are increasing the qualification thresholds for these programs by $10,000.  For 2024, an individual with an income below $52,142 can qualify for PAAD, and Senior Gold’s assistance qualification is below $62,142.  A married couple’s joint income to qualify is below $59,209 for PAAD or $69,209 for Senior Gold.  The only qualification for these programs is income; the enrollment application does not ask for assets.

The NJ PAAD program pays the premium for many prescription drug plans (Part D) and Medicare Advantage programs.  PAAD will reduce the cost of generic medications to $5 and brand-name medications to $7; however, if the medication is a prescription from one of the manufacturers that no longer participates in the program, then the state will not subsidize the cost of the medication. 

Impacted Medications for 2024

This change will have a significant impact on people who are prescribed the affected medications. Below is a list of the medications that will not be discounted in 2024. If you are enrolled in NJ PAAD or Senior Gold and take one of these medications, you may want to consider asking your doctor for an alternative.

 

 GSK Products

Advair	Anoro Ellipta	Arnuity Ellipta	Beconase AQ	Breo Ellipta
Coreg CR	Flolan	Flovent	Imitrex	Incruse Ellipta
Jalyn	Jemperli	Krintafel	Lamictal	Malarone
Mepron	Nucala	Rythmol SR	Relenza	Serevent Diskus
Trelegy Ellipta	Valtrex	Ventolin HFA	Wellbutrin SR	Zejula
Eli Lilly Products
Almita	Amyvid	Baqsimi	Cialis	Cymbalta
Cyramza	Emgality	Evista	Forteo	Glucagon
Humatrope	Jaypirca	Mounjaro	Olmiant	Portazza
Prozac	Retevmo	Reyvow	Strattera	Symbyax
Taltz	Tauvid	Trulicity	Verzenio	Zyprexa

 

 

Drug Manufacturer’s Assistance programs

The manufacturers have their own patient assistance programs, which have separate applications.

Lily Cares income qualifications

Information on Eli Lilly’s assistance program, “Lily Cares” is available at www.lillycares.com or by calling 1-800-545-6962. Lilly Cares qualifications are based on your household income, and they categorize the mediations into groups.  Not all medications are covered by the program, and Trulicity assistance is currently unavailable.

	1 Person Household*	2 Person Household*
Group 1 medications	$43,740	$59,160
Group 2 medications	$58,320	$78,880
Group 3 & 4 medications	$72,900	$98,600

*Total Number of Persons in your Household (including applicant).

 

“GSK For You” income qualifications  

Information on GSK’s assistance program, “GSK For You” is available at www.GSKforYou.com or 1-866-GSK-FOR-U (1-866-475-3678).  The GSK For You program requires applicants to pay $600 for medications before they qualify for assistance.  An application can be submitted after the $600 is spent if your income is below the threshold.

Household Size	Maximum Gross Income
1 Person	$43,740
2 Persons	$59,160

 

New Jersey Medicare Brokers can help!

If you need assistance navigating these changes to the NJ PAAD or Senior Gold program, we are here to help.  Please contact us on our website or call 800-797-0605 for assistance.