March 12, 2004


Lorazepam/Clorazepate Assistance Program



On March 29, 2004, the Department of Aging will implement the Lorazepam/Clorazepate Assistance Program known as the PA (Pennsylvania) Patient Assistance Program.

This new program reimburses for generic formulations of lorazepam and clorazepate.


Patients currently receiving either of these medications may be eligible for participation in this Program if they are:


·         a Pennsylvania resident age fifty-five (55) or older who is ineligible for other pharmaceutical assistance programs including PACE and PACENET


·        a disabled Pennsylvania resident, regardless of  age, (who can supply proof of disability to the Program .)  



Following acceptance into this Program, cardholders receive an ID card permitting them to receive the lesser of a 30 day supply or 100 units of generic formulations of lorazepam or clorazepate.   Enrolled cardholders are required to pay a $6.00 copay and are limited to a maximum daily dosage of 6 mg of lorazepate or a maximum daily dosage of 60mg of clorazepate. 


Individual cardholder eligibility lasts for a maximum of one (1) year, although the Program may end at anytime due to funding.


Cardholder enrollment or eligibility questions should be directed to:

PA Assistance Program

1-800-835-4080, Option #3.



Provider questions concerning this program should be directed to Provider Services at