• Members receive assistance for prescribed legend drugs, insulin and insulin supplies.
• Senior Gold does not pay for diabetic testing supplies (e.g., test strips and lancets). If Senior Gold beneficiaries have health insurance coverage, such as Medicare Part B that pays for diabetic testing supplies, a pharmacy must bill that insurance plan. Senior Gold will not pay for them.
• Members pay a copayment of $15 plus 50% of the remaining cost of each Senior Gold covered drug.
• Once members reach annual out-of-pocket expenses exceeding $2,000 for single persons or $3,000 for married couples, they pay only a flat $15 copayment per prescription for the balance of that eligibility period;
• A Senior Gold beneficiary must be a New Jersey resident;
• A Senior Gold beneficiary must be 65 years of age or older, or at least 18 years of age and receiving Social Security Title Disability benefits;
• A Senior Gold beneficiary must have annual income for 2023 between $42,142 and $52,142 if single or between $49,209 and $59,209 if married.
• All Medicare-eligible Senior Gold beneficiaries must participate in Medicare Part D. Senior Gold beneficiaries must pay the monthly premium directly to the Medicare Part D plan of their choice. They also are responsible for paying any late enrollment penalty imposed by Medicare for each month they were eligible to enroll in Medicare Part D but did not enroll.
• Senior Gold benefits help to make Medicare prescription drug coverage more affordable by reducing any other out-of-pocket costs associated with that coverage, such as deductibles, co-insurance, and the coverage gap known as the "donut hole."

Additional Program Information

The Senior Gold Prescription Discount program helps eligible New Jersey residents pay for prescription drugs, insulin, insulin needles and syringes and needles for injectable medicines used for the treatment of multiple sclerosis. Only drugs approved by the Food and Drug Administration are covered. Drugs purchased outside the State of New Jersey are not covered, nor is any pharmaceutical product whose manufacturer has not agreed to provide rebates to the State of New Jersey. The Senior Gold card works together with Medicare Part D Prescription Drug Plans. Senior Gold can reduce out-of-pocket expenses associated with participation in Medicare Part D.

Senior Gold is not considered creditable coverage with regard to Medicare Part D.

To apply for Senior Gold, applicants must complete the NJSave application.

If it is determined that you are eligible for Senior Gold, you should receive an identification card within 30 days. With your Senior Gold card, you pay the pharmacist $15 plus 50% of the remaining cost of the drug for each Senior Gold covered medication. Once a Senior Gold beneficiary reaches out-of-pocket expenses exceeding $2,000 for single persons or $3,000 for married couples, they pay a flat $15 co-payment for the balance of that eligibility period.

By submitting the NJSave application, you are authorizing the State of New Jersey to collect payments made on your behalf from any other assistance program, insurance or retirement benefits, which may cover prescription drugs.

If you have health insurance or retirement benefits that provide prescription coverage equal to or better than Senior Gold, you would NOT be eligible. However, you may be eligible if your health insurance or retirement plan offers limited or partial coverage.

Senior Gold beneficiaries must reapply every year.

Approximately four months before your Senior Gold card expires, you should receive a Senior Gold renewal form. Complete this form and return it by mail. Call the Senior Gold toll-free number (1-800-792-9745) if you have not received a renewal form at least two months before your card expires.

The Senior Gold program is required by law to provide generic substitutions for brand name drugs that have approved generics available. Generic drugs are less costly substitutes with the same active ingredients as drugs sold under a brand name. In order for a Senior Gold cardholder to receive a drug's brand name version instead of the approved generic version when Senior Gold is the primary payer for a prescription, the prescribing physician must request prior authorization. However, certain brand name drugs with a narrow therapeutic index or a lower cost per unit than the generic drug may be excluded from the prior authorization process.

Initial prescriptions are limited to a 34-day supply when Senior Gold is the primary payer. Subsequent refills may be dispensed up to a 34-day supply or 100 unit doses, whichever is greater. This regulation prevents the waste of medication should the initial prescription prove to be inappropriate to the beneficiary and allows persons on maintenance drugs to receive up to 100 unit doses for subsequent refills.

The State of New Jersey has established an enhanced Drug Utilization Review (DUR) component for the Senior Gold program to safeguard against harmful drug/drug interactions, doses that are too small or too large, over-extended drug therapy or drug duplication. This will not prevent you from obtaining medicine that your doctor believes to be medically necessary.

For additional information, call our toll free Hotline at 1-800-792-9745