The Wyoming Prescription Drug Assistance Program (PDAP)

PDAP is funded by the Wyoming Legislature and is administered through the Wyoming Department of Health, Division of Healthcare Financing, Pharmacy Services. 

Eligibility 

Client eligibility for the program is determined by the client’s local Department of Family Services (DFS) office: 

• Income guidelines are at 100% of Federal Poverty Level (FPL)
  • Individual Monthly Income of $907.50—Yearly Income of $10,890
  • 2 Person Household:  Monthly--$1,225.83 and Yearly--$14,710
  • 3 Person Household:  Monthly--$1,544.17 and Yearly--$18,530  

Effective June 1, 2003

AIDS drugs were no longer covered because the Aids Drug Assistance  Program (ADAP) covered all AIDS drugs. 

Effective July 1, 2003

A cap on new enrollments in the program was instituted. Clients currently eligible were continued in the program provided they completed their yearly review with DFS and still met eligibility criteria. 

Effective July 1, 2004

Begin implementation of the new asset test upon annual review.

• Must be at 100% of FPL or less
• A vehicle worth $15,000 or less, the home the client is living in, and $2,500 in resources will be excluded from the means test.  

Effective July 1, 2006

The program cap on new enrollments was lifted due to the shift of those clients eligible for Medicare Part D Prescription Services beginning January 1, 2006. 

Benefit

Three (3) prescriptions per month, with a $10 co-pay for generics and a $25 co-pay for brand-name drugs. 

Formulary

Same as for Wyoming Medicaid—a comprehensive listing can be found at http://www.epocrates.com.

Preferred Drug List 

The Preferred Drug List can be found at http://wyequalitycare.org 

The Wyoming Medicaid Pharmacy Program will not cover the following Legend Drugs: 

• Anorexiant products
• Androgenic or Anabolic steroids used for weight gain
• Agents used to promote fertility
• Acne agents for clients who are 21 years of age or older
• Agents used for the stimulation of hair growth  
• Erectile Dysfunction medications
• DESI, as well as similar, related or identical drugs considered to be less effective by the Food and Drug Administration (FDA)
• Compound prescriptions, which include a DESI drug, will deny (refer to Compound Drugs section of the Medicaid Pharmacy Provider manual for instructions on billing non-DESI ingredients.) 
• Promethazine for children 2 years of age and younger
• Orphan drugs
• Medications not approved by the FDA 

Some medications require prior authorization. Additional information may be found by clicking on the Preferred Drug List/Prior Authorization (PDL/PA) menu tab on the Office of Pharmacy Services home page.  

For additional information on product coverage, including over-the-counter products, please refer to our provider manual at http://wyequalitycare.org.  

Prescription Drug Assistance Program (PDAP) Clients—What you need to know about Medicare Part D Prescription Drug Plans?

Beginning January 1, 2006, new Medicare prescription drug plans became available to people with Medicare. Insurance companies will work with Medicare to offer these drug plans, which are different from the Medicare-approved drug discount cards.  Medicare prescription drug plans provide insurance coverage for prescription drugs. All drug plans will provide at least a standard level of coverage, which Medicare has set, but could offer more coverage and additional drugs for a higher monthly premium. When a person joins a drug plan, it is important to choose one that meets the person’s prescription drug needs. 

The Department highly recommends that PDAP clients enroll in a Medicare Prescription Drug Plan, as this is a much better benefit than that offered through PDAP.  To enroll in a Medicare plan, call 1-800-Medicare (1-800-438-5785) or visit their website at www.medicare.gov.  

 

For PDAP clients who are NOT eligible for Medicare, benefits will continue as usual.