For a lot of senior citizens who have Medicare Part D, a fixed income makes it very hard to pay for prescription medication. The Medicare Part D gap in coverage for those patients who have a chronic illness, can be very difficult. There is a lot of talk by the end of the second quarter of the year regarding the coverage gap or donut hole. How does it work, what is it, and why is it there? How does it provide prescription drug help?
To reduce the cost of Medicare’s Part D coverage, the coverage gap was created. Each year, a limit for Part D is determined. The annual amount in 2007 was 00. 10 is what the yearly amount was increased to in 2008. In 2009 the amount is ,700. The limit is calculated on the total costs of the drugs that you receive. What the insurance company pays and your co-pays are included in this calculation. For instance, if a drug is 0 and the insurance company pays 0 and the recipient pays , the amount that goes towards the yearly limit is the entire 0
You must pay for all of your drugs out-of-pocket while you are in the donute hole or coverage gap. While in the coverage gap, a lot of Medicare Part D plans will provide some type of coverage for generic drugs. The cost of most generic drugs is so low that the benefit of having them covered by a Part D plan isn’t that much of a benefit. It might be worth it to have coverage for generic drugs for some patients because everyone’s situation varies.
For Part D people with chronic health problems which often require expensive medicine for treatment, the donut hole can be reached in a matter of months. Reaching the donut hole as early as February is not uncommon. Steering patients to buy less expensive medications when possible is the reason for the donut hole or coverage gap. This punishes those patients who must take expensive prescriptions because nothing else works.
Enbrel is a medicine for patients who have rheumatoid arthritis and the high price of it can cause the patient to reach the coverage gap within two to three months. Then, they must pay for their medications at full price for several months until the catastrophic coverage portion of Part D kicks in, or suffer the potentially disabling consequences of coming off their medicine. The price of Enbrel is approximately 00 per month. Few senior citizens can actually afford that.
Because of their lower income, some patients will be able to qualify for patient assistance programs.
The best way to get low cost or free prescription drugs is to talk to the manufacturer. Call the company and ask about their Prescription Assistance Program. Almost all pharmaceutical companies offer these programs, which enable consumers to receive prescriptions they need at a price they can afford (often for free). You and your physician will need to complete an application. Patient Assistance Programs run by manufacturers have been in existence for over 16 years. These programs are designed to help eligible individuals who can’t afford their medicine due to low income or other financial problems. Pharmaceutical companies did not want their low income customers to be forced to make a choice between paying for life saving prescriptions 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, few people knew about the existence of these programs or could follow the complicated application process that was required for participation. In many cases several applications had to be filed. Please do your research and get the help with prescriptions that you need.