Pain In My Head – Relief for Headaches

On a limited budget most senior citizens on a tight income have little to no money to pay for their medicine. However, for those seniors who have a chronic condition, the Medicare Part D gap in coverage can be a tough realization. At the beginning of the second quarter of the year you hear a lot of talk regarding the donut hole or coverage gap. What is it, why is it there, and how does it work? How does it provide prescription drug help?

The coverage gap (donut hole) was created to decrease the cost of Medicare’s Part D coverage. The yearly limit for Part D is set each year. The yearly limit in 2007 was $2400.  $2510 is what the yearly amount was increased to in 2008. The amount is $2700 in 2009. The limit is calculated on the total costs of the prescription medications that you receive. This includes what the insurance company pays and your co-pays. For example, if a medication is priced at $550 and the insurance company pays $500 and the recipient pays $50, the amount that goes towards the annual limit is the full $550

You are responsible for all of your prescription medicine 100% while you are in the donute hole or coverage gap. A lot of Medicare Part D plans offer generic drug coverage when you are in the donut hole. The cost of most generics is so small that the benefit of having them covered by a Part D plan isn’t that much of a benefit. Everyone’s situation is different so for some people it might be worth it to have prescription coverage for their generic drugs.

Chronic health conditions which often require costly drugs for treatment result in Medicare Part D people getting to the donut hole or coverage gap in a matter of a couple of months. Reaching the donut hole or coverage gap as early as February is not uncommon. The point for the donut hole was to encourage people to buy less costly pharmaceuticals when possible. Because nothing else works it punishes those people who must use costly prescription medication.

Enbrel is a medication for people who have rheumatoid arthritis and the high price of it can cause the patient to reach the coverage gap within two to three months. Stopping their medicine which has potentially disabling consequences or paying for their medication at full cost is often the only option available to these patients. About $18,000 a year is the cost of Enbrel. Very few seniors can actually afford that.

Qualifying for patient assistance programs can and will assist some lower income patients.

One of the best ways to get low cost or free drugs is to talk to the manufacturer. Call the company and ask about their Prescription Assistance Program.  Almost all drug manufacturers offer such programs, which enable patients to receive prescription medicine they need at a price they can afford.  A lengthy application co-signed by your physician is typically necessary for entry into the program. Patient Assistance Programs run by manufacturers have been in existence for over 21 years. These programs are designed to assist eligible patients who can’t afford their prescription medications due to low income or other financial problems.  Pharmaceutical companies did not want their low income patients to be forced to make a choice between paying for life saving prescription medicine 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 necessary for participation. In many cases multiple applications had to be filed. Please do your research and get the help with prescriptions that you need.

 

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