Medicare and Part D

Patient Assistance Programs for Medicare Beneficiaries

December 15, 2006

The Centers for Medicare & Medicaid Services (CMS) have posted updated information on CMS policy with respect to patient assistance programs (PAPs), as well as helpful links to other information contained on the Office of the Inspector General's Web site. Pharmaceutical manufacturers may sponsor patient assistance programs (PAPs) that provide financial assistance or free supplies of prescription drugs (through in-kind product donations) to low-income individuals to augment any existing prescription drug coverage.

PAPs can provide assistance to Part D enrollees and interface with Part D plans by operating "outside the Part D benefit" to ensure that Part D benefits and PAP assistance are provided separately. PAP assistance does not count towards a Part D beneficiary's true out-of-pockets cost (TrOOP), which determines whether an individual has reached the threshold for catastrophic coverage under the Part D benefit.

The information posted on CMS’ Web site includes CMS's Coordination of Benefits guidance, PAP Data Sharing Agreement documents, an Outside the Benefit Q&A, and the PAP Attestation document. These documents can be found at the following website: www.cms.hhs.gov. CMS plans to update these resources on a regular basis.

Many of the major drug manufacturers offer assistance programs for people enrolled in Medicare Part D who have difficulty covering the cost of their medications. These programs vary by what they offer and what the eligibility criteria is for the program. You can find out whether a Patient Assistance Program is offered by the manufacturers of the drugs you take by visiting our Pharmaceutical Assistance Program site at www.medicare.gov. Contact information and program details are included and the Web site is updated once a month.

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