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"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 February 24, 2009
click for printer friendly version
 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
2009 you
will have
already paid $295 deductible plus
$601.25
of the next
$2,405)
before you fall into the doughnut hole. While in this hole, you are now
responsible for 100% of the next
$3,453,75
in medications purchased from a
Medicare-approved source. (You will never escape the hole if you buy
from Canada.) 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.
Then, on January 1, each year, it all starts over again, but with
increases in cost to you. (Read
Part D Fiasco for a more complete
explanation, and a great chart that
makes the breakdown much clearer) (A
chart for 2009,
comparing it with 2006, 2007, and 2008 has now been added.)
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."
All I need is the monkey. My wife just walked in and suggested
that we try to eat our way out. (she saw that doughnut
in my cartoon) But there must be some less drastic, or less
fattening, things we can do to survive the hole.
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:
www.needymeds.com/indices/pap.html
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. Giant Food, the
Landover, MD based retailer, began a special promotion for the
three months beginning January 1, 2009. Thirty six generic
antibiotics are FREE. Yes FREE! Watch for other unique
promotions like this from competing retailers. Read
Generic Drug Alert. The
article is at the bottom of that 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. Ask 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.
And your doctor may be willing
to help you in another way. Let's say you use 10 mg of Lipitor
every day. Ask your doctor to prescribe a 20 mg pill for once
per day, and then very carefully cut it in half to double your
days. You will still be taking 10 mg per day, but a 90 day
supply will last 180 days. And a 20 mg tablet will not
cost anywhere near double the cost of a 10mg. You must be
careful not to ask for this arrangement if a tablet is
timed-release, or if you receive capsules. I just asked my
doctor to do this, and he said., "No problem." I had first
asked him if Simvastatin would work just as well (a generic).
His response was, "We are getting such amazing results with
Lipitor, and I would rather not switch if we can avoid it."
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. My
pharmacy now charges me $4 for most generics for a 30 day
supply, and $10 for a 90 day supply.
click for printer friendly version
please tell us about your
experience with the donut hole:
seniorark@aol.com
Learn more about Part D at: Take
me to the SeniorArk Main
Medicare Page
Part D Fiasco -
Congress Can Do Better,
Part D In Chart Form,
All about Part D and
Medicare,
Does Part "D" Add Up for Me? |
