Toni:This year, I got into the “donut hole” in September. It has financially devastated and I almost stopped taking my prescriptions.  I can afford my monthly $80 co pays but on my statement, it says the actual prescription drugs cost is $950.00 per month. How can I stay out of the “Donut Hole or not get in it so fast for 2017?

Thanks, in Advance…Diane from West U. 

Hello Diane:

Your prescription drug problem is typical for the average person on Medicare whose true prescription drug cost is over $300 per month. Many believe that their monthly co pays are what takes them to the “Donut hole”.  BUT… are absolutely dumbfounded when they learn that the real cost of their prescription drugs is $950.00 each month like yours are.

For 2017, the Medicare Part D plans have changed and the cost of prescription drugs has increased. Want to know why?

The “Donut hole” will begin once the true cost of all prescription drugs whether generics or brand name reach a total of $3700 and then the fun begins.

You must pay the next $4950 to get out of the “Donut hole”. You will pay 40% for a brand name drug and the brand name drug manufacturer will pay 50% of that covered brand name drug.  Now, the remaining 10% will be paid by the prescription drug plan which you have enrolled in. For generic drugs, the cost is 51% co pay while in the “Donut hole”.

When we perform Medicare consultation with Part D planning in the Toni Says office during this Medicare Open enrollment season, it has come to our attention via the prescription drug planning site that the cost of brand name drugs has increased since 2016.

We have noticed that many brand name prescription drugs have changed from the tier 3 preferred brand name status with a simple co pay to a tier 4 non-preferred brand name drug with a 30-50% of the drug co pay. Example: Benicar which was in 2016 $30 preferred brand name drug is now a 30-50% co-pay of the true cost of Benicar $179.08 with a co pay of $89.54 or a 50% co pay.  Many Part D plans for 2017 are not covering Benicar and other brand name drugs.

Always verify with the specific prescription drug plan that you want to enroll what tier your specific prescription drug is.

  • Talk to your doctor about changing brand name to generics.
  • Get samples of prescriptions whether brand name or generic from your doctor.
  • Seeks prescription drug discount programs for brand name or generic drugs such as, HEB, Walmart, Sam’s and Costco’s discount generic program.
  • Be very aware of how the Medicare Part D plan which you have enrolled in works and what the prescription drug plan tiers are:

Tier 1:  Preferred generic (lowest cost and co pays)

Tier 2:  Regular generic (average cost and higher generic co pay)

Tier 3:  Preferred brand name: (lower brand name cost and average co pay such as $30, $40, $80, etc.)

Tier 4:  Non-preferred brand name:  30 to 50% co pay of the brand name cost example: 50% of $300 brand name drug which is $150 co pay.

Tier 5:  Specialty drugs 33% co pay…$1000 prescription drug will have a copay of $333.

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