SPAPs
Over twenty states have state pharmaceutical assistance programs (SPAPs) which generally help low-income Medicare-eligible seniors to purchase affordable prescription medications.

With the implementation of the Medicare prescription drug benefit in 2006, the SPAPs were provided with an opportunity to reevaluate their programs. Some states made the decision to terminate their SPAPs, while several states decided to wrap around the coverage provided by Medicare Part D and the low-income subsidies offered through the Medicare drug benefit. SPAPs have taken several approaches to fill the gaps in the Medicare drug benefit, including paying the premiums and cost-sharing requirements for its members, covering the drugs that are not covered by Medicare Part D, and filling the "donut hole."

Discount Programs
In addition to pharmaceutical assistance programs, some states offer prescription drug discount programs to their low-income populations. States offer discounts through the 340B drug pricing programs, which requires pharmaceutical manufacturers participating in Medicaid to offer drug discounts to federally and state-supported facilities that serve the most vulnerable populations.

States have also found ways to reduce the cost of prescription drugs for both the states and their residents, including the following:

• Offer discount card programs that have been voluntarily negotiated with pharmaceutical manufacturers
• Pass laws that require pharmaceutical manufacturers to offer rebates
• Combine the pharmaceutical needs of several states to bulk purchase drugs at a lower cost
• Allow automatic generic substitution for prescriptions written for brand-name drugs
• Offer reimportation of drugs for various groups, including state employees