Help For Prescriptions

For a lot of senior citizens who live on a tight income, Medicare Part D has been an answer to their prayer. A lot of these people don’t have much left over to pay for their much needed prescription medicine and they need help for prescriptions. For those senior citizens who have a lasting condition, it can be a tough realization when they hit the Medicare Part D gap in coverage. The coverage gap or donut hole is often talked about by the end of the first quarter of the year. How does it work, what is it, and why is it there?

To decrease the cost of Medicare’s Part D coverage, the coverage gap was created. The yearly limit for Part D is determined each year. The annual limit in 2007 was $2400.  The yearly limit was increased in 2008 to $2510. In 2009 the amount is $2,700. The total dollar amount of the drugs that you receive is how the amount is determined. This includes your co-pays and what the insurance company pays. You are responsible for all of your drugs during the time you are in the donut hole or coverage gap and this is when most people need help for prescriptions.

Many Medicare Part D plans provide generic coverage when you are in the coverage gap. The cost of most generic drugs is so small that the benefit of having them covered by a Part D plan is not that much of a benefit. Everyone’s situation varies so for some people it might be worth it to have coverage for their generics.

For Medicare patients with chronic conditions which often require high priced drugs for treatment, the donut hole or coverage gap can be reached in a matter of months. We have seen people reach the donut hole as soon as February. The reason for the coverage gap was to steer people to buy less expensive pharmaceuticals when possible. Because nothing else works it punishes those people who must use expensive prescription medicine. For instance, for patients with rheumatoid arthritis whose condition can only be successfully controlled by Enbrel, they can go into the donut hole within two or three months. This is when they need help for prescriptions. The option at this point is to pay for the medication at full cost for several months until the catastrophic coverage portion kicks in or suffer the potentially disabling consequences of stopping their prescription medication. The cost of Enbrel is roughly $18,000 per year. There are a lot of senior citizens who are unable to pay for that.

Some people will be able to sign up for patient assistance programs because of their lower income. Going directly to the pharmaceutical company can be very helpful in obtaining low or no cost medicine and getting help for prescriptions. Call the company and ask about their Prescription Assistance Program. Almost all drug manufacturers offer such programs, which enable consumers to receive prescriptions they need at a price they can afford (often for free). You and your healthcare provider will need to complete an application. Patient Assistance Programs run by drug companies have been in existence for over 23 years. These programs are designed to assist eligible individuals who can’t afford their prescription drugs due to low 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 prescription 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, few people knew about these programs or could follow the complicated application process that was required for participation. In many cases multiple applications had to be filled out in order to receive the help for prescriptions that these patients needed.