"PLEASE HELP ME I'M FALLING"
15 Things you can do today to get help with your drug costs, or to
survive a fall into the "doughnut hole"
Bob Fassbach, Editor, www.seniorark.com Updated October 29, 2014
You have studied private Part D insurance plans, signed up as requested, paid your premiums, paid the deductible, paid 25% of the first portion of your medications, and now this---the doughnut "abyss". In 2015 you will have already paid $320 deductible plus 25% of the difference between $2,960 and $320 (around $740) before you fall into the doughnut hole. While in this hole, you are now responsible for 45% of brand name drugs and 65% of the cost of generic medications purchased from a Medicare-approved source. Before Obamacare, we paid 100% for both brand and generic drugs while in the hole. (You will never escape the hole if you buy from Canada.) When your drug costs for the year exceed $6680 you leave the donut hole. Then you enter a new stage where your part D insurance picks up a major share of your expenses until the end of the year (you pay 5% or $2.65 for generics, $6.60 for brand names - whichever is greater). Then, on January 1, each year, it all starts over again, but with increases in cost to you.
So what are we to do? I considered sitting outside the drugstore with a tin cup and a sign saying, "I'm in the doughnut hole, please be generous." My wife just walked in and suggested that we try to eat our way out. (she saw that donut in my cartoon) But there must be some less drastic, or less fattening, things we can do to survive the hole.
Fortunately, after Obamacare the donut hole is not as deep, and it will be filled in even more if the Republicans leave Obamacare alone. It should be gone completely by 2020. Even so, for some, the donut hole is oppressive, and solutions for buying drugs must be found.
Before 1. Your best defense against the doughnut hole is an aggressive offense. There are immediate steps you can take that may help you to avoid the hole altogether. Read "Surviving With Medicare Part "D" to see how this may be possible.
1. Apply for Extra Federal Help., There is a federal program that helps pay for some or most of the costs of Medicare prescription drug coverage, if your income and assets are low enough to qualify. website.
2. Determine what your state has to offer. Many states have programs to help with prescription medicine based on income. Pennsylvania, with a program called Pace/Pacenet, assists seniors with medication costs. even through the doughnut hole. For a couple the income threshold is around $31,500, including all sources of income. You may have premiums or co-pays, but the savings can be worth thousands. Your state may have a similar program that you did not know existed. Go to the SeniorARK government links page, click your state on the map, and start investigating.
3. Contact the company that makes your medication. Before part D was available, many drug companies had programs that offered to reduce the price on their drugs based on a sliding scale of income. From time to time they even gave the medication for free. Some have stopped this practice, but others have not. Give it a try. The major medication manufacturers are listed in SeniorARK, and you will find email addresses and telephone numbers. You may also find some specific programs offered by drug companies at this address:
4. Contact Partnership for Prescription Assistance (PPP) This is how they describe their work: The Partnership for Prescription Assistance brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them. Many will get them free or nearly free. Its mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible.
5. Visit those who know. Go to your local agency on aging, or even your local Social Security office to ask for some direction. There are private agencies out there that are not well-publicized, but those who work with the elderly know about them. Also, go to the local senior center, Talk around and you may hear some great tips.
6. Comparison shop There are great differences in drug prices from outlet to outlet. Go in and ask them. Wal-mart has reduced the prices on select drugs to $4 each, and Target and others have come out with their own plans. The Giant Eagle Supermarket chain in my area has just reduced 400 prescriptions to a $4 price. Yesterday I read about a Midwest chain that was giving 7 different antibiotics for FREE. I am so sorry that I did not keep the name. Read Generic Drug Alert. The article is at the bottom of the page when you click on the link. This article is important for the next area as well.
7. Have a talk with your pharmacist. Your pharmacist may have some valuable tips for you on organizations of value. But he/she can help you in many other VERY VALUABLE WAYS. If you did not click on the Generic Drug Alert article when you were reading tip #5 above, then you will want to do it now. It is a great directive on how to work with your pharmacist to save big bucks.
8. Tell your doctor that you cannot buy a medication. Your doctor has piles of sample medications that can help you over a hump. And perhaps he/she can suggest an organization of value to you. Having a prescription redirected to a generic can save you a lot of money. And there may be another, cheaper drug, that will do the same thing. As your doctor to review your medications to see how you can cut costs. This is a good idea LONG BEFORE YOU EVEN COME CLOSE TO THE DOUGHNUT HOLE. You may save so much that you will take much longer to reach the hole, or you may be saved from reaching it at all.
9. Talk to Your Doctor about Switching to Cost-Effective Drugs As millions of seniors and disabled fall into the Medicare Part D “donut hole” coverage gap in coming weeks, Consumer Reports Best Buy Drugs urges beneficiaries to talk to their doctor about switching to cost-effective medications that will dramatically cut their out-of-pocket costs for prescriptions. And many are taking drugs that are more expensive than others that do the same thing, just as well.
Many seniors and disabled are now finding they have to pay the full cost of their prescriptions due to the Medicare coverage gap, which is a very scary proposition for those on fixed incomes,” said Gail Shearer, health policy director for Consumers Union, publisher of Consumer Reports. “We urge beneficiaries to talk to their doctors about switching to low-cost, effective drugs so they don’t have to choose between their needed medications and basic necessities.”
10. Contact your elected officials. If you read my article earlier, Part D Fiasco, you learned that I am no fan of Part D. I think it is "slight-of-hand" except for those needing catastrophic amounts of medicine. That could be you or me tomorrow, and we may be grateful that we have part D. But Congress needs to change the program from the bottom up. Please read the article. You can cause change to happen by contacting your Senators and Representatives. Tell them that Part D must be improved, and that the doughnut hole must be eliminated. We must negotiate for lower prices with the drug companies (they lobbied against that when the bill was written). Go back to our government links page where you can connect with your elected officials. They WILL listen.
11. Get an online Benefits Checkup on the availability of affordable healthcare and prescription drugs. It is produced by NCOA (National Council on Aging) at the US Department of Health and Human Services. This is an interactive exercise that helps you learn about and sign up for valuable public and private programs that can save you money on your health care and prescription drugs. This includes the Extra Help through the Medicare Prescription Drug Coverage, State Pharmacy Assistance Programs, Company Patient Assistance Programs and other important federal and state programs. You may apply for the Extra Help below or after you complete a Benefits Check-Up questionnaire.
12. Apply for assistance from a certified charity that helps pay your out-of-pocket costs. What a charity pays for your drug costs will count toward the $3,600 out-of-pocket costs you must pay in order to reach catastrophic coverage. To be able to do so, however, the charity cannot be affiliated with a specific pharmaceutical company. Support from a traditional pharmaceutical manufacturer's patient assistance program will not count toward your out-of-pocket costs to reach catastrophic coverage under Part D.
13. Call your Part D insurance provider. Talk with a representative of the company that has been covering your prescriptions until now, and see if they can help in any way.
14. Hospitals Some hospitals may have a Charity Care Policy that can reduce your drug copays on a sliding scale (based on your income). Ask the hospital pharmacist if you qualify for help. You will then need a prescription written by a doctor in the hospital that you fill at the hospital’s pharmacy. Note: Make sure your hospital pharmacy is in your drug plan’s network so that Charity Care payments count towards your catastrophic coverage limits.
15. 90 - Day Supplies Save Money I recently asked my doctor to rewrite my 8 prescriptions for a 90-day-supply instead of a 30-day-supply. I reasoned that it would be more convenient for me to pick up medications every 90 days, rather than monthly. Imagine my surprise when told by the pharmacist that the cost of each of the medications was identical for 90 days OR 30 days. He said he had double checked all of them, and it was true. He also juggled the dates on the prescriptions so I could pick up ALL 8 on the same exact date. A helpful pharmacist is worth his or her weight in , well, Zoloft.