Patient Assistant Programs and Medicare Part D - Pharmaceutical Executive


Patient Assistant Programs and Medicare Part D
About 2.5 million low-income seniors who participate in pharma's access programs are eligible for drug coverage under Medicare Part D. But the programs are out of alignment—and may leave some patients...

Pharmaceutical Executive

PFIZER AND BMS Pfizer and Bristol-Myers Squibb, which have two of the largest PAPs, will continue to offer their programs to Medicare-eligible patients who do not have prescription drug coverage and decide not to enroll in one of the Part D plans. At the same time, both companies are actively participating in and promoting the Partnership for Prescription Assistance, a single point of access to more than 275 PAPs, including more than 150 offered by pharmaceutical companies.

ELI LILLY The LillyAnswers program allowed seniors and people with disabilities under Medicare to pay a flat $12 fee for a 30-day supply of certain retail-distributed Lilly drugs, such as the osteoporosis drug Evista (raloxifene), Humalog (insulin), and antidepressant Cymbalta (duloxetine), among other medicines. The Indianapolis-based drug maker said it will continue to offer its discount program for Medicare-eligible seniors through the last day of open enrollment, May 15, 2006, to offer seniors a "bridge" to the more comprehensive Part D plan. To help patients make the switch, the company established the Lilly Medicare Education hotline to answer questions for individuals interested in enrolling in the Medicare program.

ASTRAZENECA AstraZeneca also set up a toll-free hotline to help members of the AstraZeneca Foundation Patient Assistance Program understand their Part D plan options and make a trasition to the new program. As of December 31, Medicare-eligible members of the company's PAP no longer qualify for that program. Prior to this decision, uninsured US citizens of all ages with a valid Social Security number, who had an annual income below $18,000 per individual or $24,000 for couples and met the requirements of the program, were eligible to receive AstraZeneca products like Crestor (rosuvastatin) and Nexium (esomeprazole) for free.

Other companies are facing similar dilemmas but many, especially smaller pharmas, have yet to announce decisions about their PAPs. Many patients and healthcare providers are anxiously awaiting word.

PAPs have become the only safety net for many individuals who need but lack the income to pay for drugs or drug coverage plans. That said, the healthcare and governmental communities will closely watch how these humanitarian programs fit into the Part D environment. OIG in particular will scrutinize pharma's response to the plight of its former patients.

However, while drug companies change their philanthropic programs for seniors so that they align with Part D, it's important to remember that companies will still run robust charitable initiatives. Although nearly one-third of patients enrolled in PAPs are over age 65, the great majority are younger and will still need assistance. Thus, an opportunity is emerging to improve care for those who remain eligible for PAPs after Part D implementation. This can be accomplished by using some of the dollars saved when PAP patients shift to Part D coverage to expand access to drugs for those who still qualify for PAPs, such as the working poor.

Bill Shearer is executive vice president and COO of The Franklin Group. He can be reached at


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