(Pennsylvania Patient Assistance Program)


Provider Bulletin

July 27, 2007


Effective Tuesday, July 31, 2007 PAP will begin enrolling eligible patients into a new program.


In addition to enrolling eligible cardholders in the Lorazepam/Clorazepate program, eligible Pennsylvania residents may enroll in the Pennsylvania Patient Assistance Program (PAP) to receive the following prostate cancer medications: Casodex®, flutamide, Lupron® and Zoladex®. 


Cardholders accepted into PAP will receive a paper card (example below) bearing the cardholder’s name, copay amounts and a code identifying the medication they are eligible to receive. As with PACE/PACENET cards, no ID number is printed on the card because of HIPAA regulations. Providers may either ask the cardholder or contact Provider Services for this information. The cardholder’s beginning date of eligibility for the specific program in which the cardholder is enrolled also appears on the card.


The medication codes are as follows:


0L = lorazepam

0C = clorazepate

1C = Casodex ®        

1F = flutamide           

1L = Lupron® 

1Z = Zoladex®   



                                                Copay $6.00 Generic

1C                                                       $9.00 Brand


John Cardholder                               July 31, 2007






Medication code








Questions may be directed to Provider Services at

1-800-835 4080.