Over the past few months, the press, including the MGH Community News, has reported that some pharmaceutical companies were planning to discontinue patient assistance programs for low-income Medicare enrollees. The companies claimed that they had to do this to avoid violating federal law. The Centers for Medicare and Medicaid Services recently clarified that pharmaceutical companies can continue their assistance programs for Medicare clients, even those who sign up for a Part D plan. In a letter to the president and CEO of The Pharmaceutical Research and Manufacturers of America, Michael Leavitt, Secretary of Health and Human Services writes “Recent guidance from the Centers for Medicare & Medicaid Services (CMS) and the Office of the Inspector General (OIG) make clear that lawful opportunities exist to provide drug assistance to Medicare beneficiaries.” The letter continues “specifically, PAPs (Patient Assistance Programs) can continue to assist Part D enrollees through a properly structured program that operates entirely outside the Part D benefit. Under this approach, the beneficiary does not use his or her Part D benefit to obtain the drug and the cost of the drug is not applied toward the enrollee’s true out-of-pocket costs.”
It remains to be seen how the pharmaceutical companies will respond. If you have any patient experiences to share, please contact the CRC.
-Adapted from “Advisory on Medicare Part D and Patient Assistance Programs” e-mail from Kathleen Kehoe, MPH, Phs Comm Benefits, February 03, 2006 and CMS “Tauzin” letter retrieved from https://www.cms.hhs.gov/apps/files/factsheets/Tauzin%20PAP.pdf on February 28, 2006.
02/06