The Limited Income NET (LI NET) Program is designed to eliminate gaps in coverage for low-income individuals transitioning to Medicare Part D drug coverage.

Point-of-sale prescription drug coverage

The LI NET Program ensures that individuals with Medicare’s low-income subsidy (LIS), or Extra Help, who are not yet enrolled in a Part D prescription drug plan, are still able to obtain immediate prescription drug coverage. If an individual is later determined to be ineligible because he or she does not receive the LIS, the individual will be financially responsible for claims already paid on his or her behalf.

Retroactive prescription drug coverage

The LI NET Program provides retroactive coverage for new dual eligibles (those individuals who are eligible for both Medicare and Medicaid or Medicare and Supplemental Security Income [SSI] from the Social Security Administration). Medicare automatically enrolls these individuals into the LI NET Program for eligible periods with an effective date retroactive to the start of their full-benefit dual-eligible status. Enrollment in the LI NET Program is temporary until Medicare enrolls these individuals in a standard Medicare Part D plan for the future.

Frequently used program resources

Opioid-related point-of-sale edits, PDF opens new window

Limited Income NET medications list, PDF opens new window

This list highlights drug categories excluded from Medicare Part D coverage by law and drugs not payable under the program.

Limited Income NET enrollment form, PDF opens new window

The enrollment form should be completed when information such as the beneficiary’s low-income subsidy (LIS) status is not visible in Medicare’s systems and it is preventing claims from processing at the point of sale. Best available evidence (BAE) will need to be provided to prove the beneficiary’s eligibility for LIS, Medicaid or Supplemental Security Income (SSI).

Low-income subsidy requirement, PDF opens new window

Requirement for point-of-sale enrollment.

Limited Income NET Program brochure, PDF opens new window

This brochure offers an overview of the LI NET Program and key contact information.

Four steps for pharmacy providers, PDF opens new window

This flier provides an overview of Medicare’s Limited Income NET claim submission process for pharmacy providers.

Limited Income NET Program payer sheet for NCPDP Version D.0, PDF opens new window

This document provides detailed information on the claim submission process using National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Version D.0.

LI NET Program questions and answers, PDF opens new window

This document offers answers to frequently asked questions about Medicare’s LI NET Program.

Improving drug utilization review controls on Part D, opens new window

Effective January 1, 2019, the Centers for Medicare & Medicaid Services (CMS) announced new strategies to further help Medicare Part D sponsors prevent and combat opioid overuse, including additional safety alerts at the time of dispensing as a proactive step to engage both patients and prescribers about overdose risk and prevention. Find more information at CMS Improving Drug Utilization Review Controls in Part D., opens new window

Medicare’s LI NET Program tutorial

Limited Income NET advocacy module, opens new window

Watch this presentation to learn how the LI NET Program eliminates gaps in prescription drug coverage for low-income Medicare beneficiaries. The tutorial also educates viewers on immediate-need coverage, retroactive coverage and program enrollment.

Additional forms and resources for pharmacy providers

Resources for beneficiaries

Beneficiary letter, PDF opens new window

A letter mailed to individuals who have qualified for Medicare’s LI NET Program.

Fact sheet, PDF opens new window

An overview of the LI NET Program for beneficiaries.

544 Direct Member Reimbursement Form – English, PDF opens new window

544 Direct Member Reimbursement Form – Spanish, PDF opens new window

Beneficiaries who have paid out of pocket for prescriptions during eligible periods should complete this form to request reimbursement.