Using Prescription Drug Plans

Determining the PDP enrollment status of a client.
The PDP Finder can be used to identify an individual’s plan. Take the example of a client who comes to their case manager not knowing if they have been auto enrolled in a Medicare plan.The case manager can use the PDP Finder and enter the following client information to determine the plan name: health insurance claim number, date of birth, last name, Medicare Part A or B effective date, and zip code of record. For those clients not currently enrolled but with a future enrollment date, the PDP Finder will show details about their future plan. Individuals can also call 1-800-MEDICARE (800-633-4227) to get enrollment information.

Rules for Patient Assistance Programs (PAP) under Medicare Part D.
Patient assistance programs (PAPs) are programs that provide free medication or financial assistance to patients who otherwise lack the means to obtain needed therapies. Many PAPs, particularly those that provide free or reduced-cost medications, are sponsored by pharmaceutical manufacturers. Many ADAPs work with PAPs to provide antiretroviral drugs to clients, particularly in providing drugs to those on ADAP waiting lists who have no other way to pay for their drugs. Under Medicare rules issued in April 2006, PAPs may provide assistance to Medicare beneficiaries but such assistance will not count toward TrOOP.