For most senior citizens who live on a tight income, Medicare Part D has been the answer to their prayer. The Medicare Part D coverage gap for those seniors who have a chronic condition, can be a real shock. There is much talk by the end of the first 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 decrease the cost of Medicare's Part D coverage. Each year, a limit for Part D is determined. The annual amount in 2007 was $2400. $2510 is what the annaul amount was increased to in 2008. $2700 is the amount in 2009. The total costs of the prescription medications that you receive is how the amount is calculated. This includes what the insurance company pays and your co-pays. is applied toward the annual limit is the entire amount of $550.
You must pay for all of your prescription medicine while in the coverage gap. There are several Medicare part D plans that provide coverage for generics when you are in the donut hole. The cost of most generics is so low that the benefit of having them covered by a plan is not that great of a benefit. Everyone's situation varies so for some people it might be worth it to have coverage for their generic drugs.
For Medicare people with chronic health conditions which often require expensive medicine for treatment, the donut hole can be reached in a matter of weeks. We have witnessed patients get to the donut hole as early as February. The whole point for the coverage gap was to steer people to purchase less expensive pharmaceuticals when possible. This punishes those patients who must take high priced prescription medications because nothing else works. Enbrel is a medicine for patients with rheumatoid arthritis and the cost of it can cause the patient to go into the donut hole or coverage gap within two to three months. Stopping their medication which has potentially disabling consequences or paying for their medicine at full cost is frequently the only option available for these patients. Approximately $50 a day is what Enbrel costs. There are a lot of seniors who are unable to pay that.
Some people will be able to take advantage of patient assistance programs
due to their income. The best way to get low cost or free prescriptions is to talk to the drug manufacturer. Contact the company and ask about their Prescription Assistance Program. Most all drug manufacturers offer such programs, which enable people 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 pharmaceutical companies have been in existence for over 19 years. These programs are designed to help eligible patients who can't afford their medicine due to low income or other financial problems.
Manufacturers did not want their low income customers to be forced to make a choice between paying for life saving medications 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, very few people knew about these programs or could follow the complicated application process that was required for participation. Often times multiple applications had to be filed with several different pharmaceutical companies in order to gain access to prescription assistance programs.
The drug manufacturers seem to believe that providing information on their websites and toll-free numbers is essentially all that patients need to access PAPs. They don't appear to appreciate the inability of many people, particularly those on multiple prescriptions from 2 or more doctors to follow through with the fragmented application process. It also places an unfair burden on the healthcare providers that are already overburdened with paperwork. Fortunately there are companies that will perform the task for people for a fee. These prescription assistance companies will generally coordinate the process from beginning to end. Of course the prescriptions are free and if people are capable of doing it themselves they should, but for those patients that just don't have the capacity to do it themselves, the hiring of a firm to do the job is a better option than not taking the prescription drugs they need.
Information about the Author:
Do you need prescription drug help. Kirby Horton has been helping Americans with their healthcare needs for close to 30 years. He is the Founder of Rx Help. a Prescription Assistance Company. He can be reached at 866-960-9497 and you can follow his blog at Rx HELP Blog .