Part D's impact on PAPs

July 10, 2006

Prior to the implementation of Medicare Part D, many senior citizens depended on prescription assistance programs (PAPs) offered by pharmaceutical manufacturers. These programs provide free or low-cost prescription medicine to low-income people who meet the eligibility guidelines.

Prior to the implementation of Medicare Part D, many senior citizens depended on prescription assistance programs (PAPs) offered by pharmaceutical manufacturers. These programs provide free or low-cost prescription medicine to low-income people who meet the eligibility guidelines.

CMS issued a statement last fall warning drug companies that it might be illegal to offer PAPs to people on Medicare. As a result, many pharmaceutical companies announced that they would not make their PAPs available to Medicare patients even if they did not enroll in Part D.

However, keeping track of PAPs and Part D policies remains difficult because manufacturer responses to this latest opinion are shifting and not in agreement. Some drug companies are not offering their programs to any patients on Medicare. Others restrict their programs to Medicare patients who do not enroll in a Part D plan. Some help Part D enrollees if their drugs are not covered by their Part D plans. A few companies offer their assistance programs to Part D enrollees who have been turned down for the Part D subsidy.

It is necessary to contact each PAP directly to get the latest information. However, there are at least two Web sites that are tracking new developments and have up-to-date information in a single location. They are NeedyMeds at http://www.needymeds.com/ and RxAssist at http://www.rxassist.org/docs/medicare-and-paps.cfm.

These Web sites allow you to search by brand and generic drug names, by company, and by program name to access the relevant source of help. While the sites do not process applications, they serve as an information portal, post application forms for the various programs, offer tips to help with the paperwork, and provide links to assistance from organizations that operate on a local basis or focus on a specific disease.

CMS is clear and consistent on one point. Any medicine provided by a PAP cannot count toward the $3,600 true out-of-pocket (TrOOP) expenses that Medicare enrollees must spend to cover the coverage gap in which they pay 100% of drug costs. Patients facing out-of-pocket expenses of several thousand dollars as they enter the payment gap in Part D plans may want to seek help to cover their expenses.

Congress steps in

Sen. Chuck Grassley (R, Iowa), who is chair of the Senate Finance Committee, has been monitoring the situation, and in May, he convened a meeting between the committee and the pharmaceutical companies. He pledged his support for continuing the prescription assistance programs. He acknowledged that one of the remaining issues is whether the cost of medications provided by PAPs will be counted toward the TrOOP costs. At least five companies have proposed a joint PAP that would allow medicine provided by a PAP to count toward reaching the other side of the gap.

Grassley would like drug companies to offer PAPs to Part D enrollees with incomes between 135% and 150% of the federal poverty level rather than just to those with an income above 150% of the poverty level.

With all the changes happening almost daily, the best recommendation to persons with Medicare is to contact the PAPs directly if there is any doubt about their possible coverage.

THE AUTHOR is associate professor, Department of Pharmacy Health Care Administration, University of Florida College of Pharmacy.