Medicare Part D became available in 2006, offering millions of Americans the potential for improved access to medications. Certain aspects of the program have been problematic or confusing for vulnerable beneficiaries, but creative efforts across the country have helped individuals obtain and use the Part D benefit. Coalitions supply the information, training, and support that community partners need for outreach, education, and enrollment activities. Trusted local organizations provide one-on-one counseling for culturally and linguistically diverse populations. States have expanded eligibility criteria for the Medicare Savings Programs, thereby increasing the pool of beneficiaries deemed eligible for the Part D Low-Income Subsidy. In redesigning state-funded prescription programs, states fill coverage gaps for beneficiaries and extend coverage for others. Wider use of these practices has the potential to substantially improve the Medicare Part D program for the most vulnerable beneficiaries. Achieving this, however, will require continued and enhanced federal and state support.