The Conservative Nation

Medicare Part D And The Cost Of Prescription Medication

Medicare Part D has been a God-send for a lot of seniors who may be on a fixed income and have a limited budget to spend on prescription drugs. However, for those senior citizens who have a lasting illness, the Medicare Part D ?donut hole? can be a real shock.

By the end of the second quarter of the year there is much talk regarding the coverage gap or donut hole. What is it, why is it there, and how does it work? Prescriptions help so many patients but only if they can get them!

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. In 2007, the annual amount was $2400. In 2008, the annual amount was increased to $2510. In 2009 the amount is $2,700. The amount is calculated on the total costs of the drugs that you receive. This includes what the insurance company pays and your co-pays.

For example, if a drug is $550 and the insurance company pays $500 and the patient pays $50, the amount that goes towards the yearly limit is the full $550

During the time your are in the donut hole, you must pay for all of your prescription medication out-of-pocket. There are many Medicare part D plans that offer coverage for generics when you are in the coverage gap. This really isn?t that great of a benefit because these plans tend to cost more per month than most generic drugs many people it might be worth it to have prescription coverage for generic drugs, everyone?s situation is different.

For Medicare people with chronic health conditions which often require costly medication for treatment, the coverage gap can be reached in a matter of people reach the donut hole or coverage gap as early as February. The reason for the donut hole was to encourage patients to buy cheaper pharmaceutical products when possible. That is fine for those people who have that option but it punishes those who must use costly prescription medications because nothing else works. For example, for patients with rheumatoid arthritis whose disease can only be successfully controlled by Enbrel, they can go into the donut hole or coverage gap within two or three months. Then, they must pay for their prescription medicine at full price for the remaining months until the catastrophic coverage portion of Part D kicks in, or suffer the potentially disabling consequences of coming off their medicine.

The cost of Enbrel is roughly $1,500 per month. There are many seniors who are not able to afford for that.

Some people will be able to qualify for Prescription Assistance Programs because of their lower income. Going directly to the manufacturer can be most helpful in getting low or no cost prescriptions. Call the company and ask about their Prescription Assistance Program. Almost all pharmaceutical companies 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 doctor is typically necessary for entry into the program.

Patient Assistance Programs run by manufacturers have been in existence for over 22 years. These programs are designed to help eligible individuals who can?t afford their prescription medications due to limited income or other financial hardships. Manufacturers did not want their low income patients 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, very few patients knew about the existence of these programs or could follow the complicated application process that was necessary for participation. In many cases multiple applications had to be filed

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