Federal Officials Approve PAPs that Assist Medicare Beneficiaries Enrolled in Part D

A new opinion from the Inspector General of DHS gave approval to drug manufacturers to supply free medicine to low-income individuals who are not only eligible for Part D but also enrolled in a Medicare drug plan.

This is a reversal of a November alert that patient assistance programs for Medicare beneficiaries might be illegal. 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.

The recent opinion was in response to a request from Schering- Plough which is seeking to continue its PAP coverage for Medicare beneficiaries who still need help with cost of medicine. Some patients are faced with paying several thousand dollars for the Òdonut holeÓ as well as the premiums and the 25% of the cost of the medicine which they must pay when enrolled in Part D.

The recent opinion did make it clear that any medicine provided by the PAPs cannot count toward the $3,600 out-of-pocket (TrOOP) expenses that a Medicare enrollee must spend to get to the other side of this donut hole or gap during which they must pay 100% of the drug costs.

Glaxo SmithKline has said it will ask the inspector general to approve its patient assistance programs for Medicare Part D enrollees.

Click HERE to read the full report: http://oig.hhs.gov/fraud/docs/advisoryopinions/2006/AdvOpn06-03F.pdf

Created 4/18/06