For a lot of seniors who have Medicare Part D, a fixed income makes it very hard to pay for prescription drugs. The Medicare Part D coverage gap for those seniors who have a lasting illness, can be a real shock. There is quite a bit of talk during the second quarter of the year regarding the coverage gap or donut hole. What is it, why is it there, and how does it work? How does it provide prescription drug help?
Medicare’s Part D cost was reduced by creating the coverage gap. Each year, a limit for Part D is determined. 00 was the 2007 annual amount. In 2008, the yearly amount was increased to 10. The amount is 00 in 2009. The total dollar amount of the drugs that you receive is how the limit is calculated. This includes what the insurance company pays and your co-pays. For instance, if a prescription medication costs 0 and the insurance company pays 0 and the patient pays , the amount that goes towards the annual limit is the full 0
During the time you are in the donut hole or coverage gap, you are responsible for the cost all of your prescription medication. Many Medicare Part D plans offer generic drug coverage when you are in the donut hole or coverage gap. The cost of most generics is so small that the benefit of having them covered by a plan isn’t that much of a benefit. Everyone’s situation varies so for some patients it might be worth it to have prescription coverage for their generics.
Chronic conditions which often require high priced drugs for treatment result in Medicare people getting to the coverage gap in a matter of months. We have seen people get to the donut hole as soon as February. The reason for the donut hole or coverage gap was to encourage people to buy less expensive pharmaceuticals when possible. This punishes those people who must use expensive prescription medications because nothing else works.
People with rheumatoid arthritis can go into the coverage gap within two or three months due to the high cost of Enbrel. The option at this point is to pay for the prescription drug at full cost for several months until the catastrophic coverage portion applies or suffer the potentially disabling consequences of coming off their prescription medication. About ,500 per month is the cost of Enbrel. Few senior citizens can actually afford that.
Because of their income level, some people will be able to take advantage of patient assistance programs.
Going directly to the pharmaceutical company can be most helpful in obtaining low or no cost prescription drugs. Contact the company and ask about their Prescription Assistance Program. Most all pharmaceutical companies offer these programs, which enable people to receive medicine they need at a price they can afford (often for free). A lengthy application co-signed by your healthcare provider is typically necessary for entry into the program. Patient Assistance Programs run by manufacturers have been in existence for over 23 years. These programs are designed to assist eligible people who cannot afford their prescription medicine due to limited income or other financial problems. Drug manufacturers did not want their low income customers to be forced to make a choice between paying for life saving drugs or for paying for rent or groceries. As a result, patient assistance programs came into being as part of the company’s philanthropic efforts. Until relatively recently, very few people knew about the existence of these programs or could follow the complicated application process that was necessary for participation. In many cases multiple applications had to be filed. Please do your research and get the help with prescriptions that you need.