Medicare Part D has been a blessing for a lot of seniors who may be on a tight income and have a limited budget to spend on prescription medications. There sometimes isn’t much left over to pay for their prescription medication and these prescriptions help the patient live a better life. For those patients who have a lasting illness, it can be very difficult when they hit the Medicare Part D coverage gap. There is much talk during the second quarter of the year regarding the donut hole or coverage gap. What is it, why is it there, and how does it work?
The coverage gap (donut hole) was created to reduce the cost of Medicare’s Part D coverage. The yearly limit for Part D is determined each year. The yearly amount in 2007 was $2400. The yearly limit was increased to $2510 in 2008. $2700 is the amount in 2009. The limit is calculated on the total costs of the prescripion drugs that you receive. What the insurance company pays and your co-pays are included in this calculation.
During the time you are in the donut hole or coverage gap, you must pay for the cost all of your drugs. While in the donut hole or coverage gap, many Medicare Part D plans will offer some type of coverage for generics. This really is not that much of a benefit because these Part D plans tend to cost more per month than most generics actually cost. Everyone’s situation varies so for some people it might be worth it to have coverage for their generic drugs.
For Medicare patients with chronic health conditions which often require costly medication for treatment, the donut hole or coverage gap can be reached in a matter of months. The prescriptions help you with your condition but who will help you pay for the medicine? Reaching the donut hole as early as February is not uncommon. The reason for the donut hole was to encourage patients to buy less expensive pharmaceuticals when possible. This punishes those patients who must take high priced prescription medicine because nothing else works. Patients with rheumatoid arthritis can go into the coverage gap within two or three months because of the high price of Enbrel. Stopping their medicine which has potentially disabling consequences or paying for their medication at full cost is frequently the only option available for these patients. Approximately $1,500 a month is the cost of Enbrel. Very few senior citizens can actually afford that.
Patient assistance programs will assist those people who qualify. Going directly to the drug company can be most helpful in getting low or no cost prescription drugs. Call the company and ask about their Prescription Assistance Program. Most all pharmaceutical companies offer such programs, which enable patients 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 18 years. These programs are designed to assist eligible patients who cannot afford their prescription medications due to limited income or other financial hardships. Drug manufacturers did not want their low income patients to be forced to make a choice between paying for life saving prescriptions or for paying for rent or groceries. These prescriptions help people so that wanted to give them away. 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 these programs or could follow the complicated application process that was necessary for participation.
