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State of Rhode Island and Providence Plantations

Department of Human Services
Division of Elderly Affairs
74 West Road
Cranston , RI 02920

RIPAE REIMBURSEMENT APPLICATION INSTRUCTIONS

Rhode Island Pharmaceutical Assistance to the Elderly (RIPAE) program

enrollees are eligible for reimbursement only when they enter the

coverage gap (“donut hole”) of their Medicare Prescription Drug Plan

(Medicare Part D)

To apply for a reimbursement, please submit these required documents:

  • Completed and signed RIPAE Reimbursement Program application (available on DEA website)
  • Copy of your most recent Explanation of Benefits (EOB) from your Medicare Part D plan
  • Your most recent year-to-date pharmacy expense printout
  • A copy of your Medicare (red, white, and blue) card

 

Please send your completed application packet to:

RI Division of Elderly Affairs
74 West Road , Hazard Bldg., 2 nd Floor
Cranston , RI 02920
Attn: RIPAE Reimbursement Program

 For additional information, please call DEA at

401-462-3000 or TTY 401-462-0740

 PLEASE NOTE:

Application submission does not guarantee a reimbursement. RIPAE will issue checks

for any approved coverage gap (‘donut hole”) reimbursement amount soon after the application is processed.

For a copy of the RIPAE Reimbursement Application Click Here