Guide · sources and program records linked below
Can Medicare patients use manufacturer patient assistance programs?
Some people with Medicare can, depending on the program and the medication. CMS says these programs can serve Part D enrollees outside the Part D benefit, and that the help does not count toward true out-of-pocket costs. As read on 10/31/26, AZ&Me accepts people with Medicare who are not eligible for or enrolled in Extra Help, and NovoCare accepts Medicare for its insulins but not for Ozempic if you have drug coverage.
What CMS and four programs say about Medicare, and what to check first: Extra Help and the yearly out-of-pocket limit.
The short answer
- Each maker sets its rule, sometimes by medication.
- Some programs ask for an Extra Help denial first.
- Program help does not count toward true out-of-pocket costs.
What CMS says
CMS explains that manufacturers may sponsor programs that give financial help or free donated drugs to people with low incomes, in addition to any coverage they have. These programs can operate outside the Part D benefit to keep the two kinds of help separate, and their assistance does not count toward true out-of-pocket costs. Medicare.gov adds that eligibility varies by company, so you need to check with the manufacturer.
What four programs say
These rules were read on 10/31/26 and can change. They are examples, not a complete list.
| Program | Rule for people with Medicare |
|---|---|
| NovoCare (source) | Novo Nordisk insulins: household income up to 400% of the federal poverty level, with proof of an Extra Help denial below 150%. Ozempic: people with drug coverage are no longer eligible. |
| AZ&Me (source) | Accepts Medicare, but no other government or private insurance. You must not be eligible for or enrolled in Extra Help. |
| Pfizer RxPathways (source) | People with Part D or Medicare Advantage must enroll in the Medicare Prescription Payment Plan and confirm they have not reached their yearly limit. |
| Eisai (LENVIMA) (source) | Federal health program beneficiaries who qualify are enrolled for the entire calendar year. Its co-pay program is not available to people in state or federal programs. |
Check Extra Help first
Extra Help is the Medicare program that helps pay Part D costs. For 2026, Medicare.gov lists income limits of $23,940 for an individual and $32,460 for a married couple, with resource limits of $18,090 and $36,100. By our arithmetic, those incomes equal 150% of the 2026 federal poverty guidelines for those household sizes. That matters because NovoCare requires proof of an Extra Help denial from Medicare insulin patients below 150%.
The yearly limit and the payment plan
For 2026, Medicare.gov puts the out-of-pocket limit for covered Part D drugs at $2,100, and at $2,400 for 2027 (read on 10/31/26). That total includes certain payments made on your behalf, such as through Extra Help, and contributions from a State Pharmaceutical Assistance Program may count. The Medicare Prescription Payment Plan spreads those costs across the year but does not lower them.
Other options
Independent charities are another route. A 2005 OIG news release says manufacturers may make cash donations to independent charity programs with appropriate safeguards. See also the kinds of help and the income limits. Your State Health Insurance Assistance Program offers free help applying for Extra Help, according to Medicare.gov.
Sources and next steps
- CMS: manufacturer patient assistance program information (modified 09/10/24) · Read 10/31/26
- Medicare.gov: Medicare drug coverage costs · Read 10/31/26
- Medicare.gov: help with drug costs · Read 10/31/26
- Medicare.gov: Medicare Prescription Payment Plan · Read 10/31/26
- HHS OIG: news release of 11/11/05 · Read 10/31/26
- NovoCare · Read 10/31/26
- AZ&Me FAQ · Read 10/31/26
- Pfizer RxPathways · Read 10/31/26
- Eisai Patient Support (LENVIMA) · Read 10/31/26
- Programs and their current source records
This is information about program rules. Confirm the current terms with the program or plan. Treatment decisions belong with your prescriber.
Check what you qualify for