Toni:

Last year, my mother got into the “donut hole” in October.  I can see from the Part D statement she receives that she is rapidly approaching the donut hole and it is only the beginning of May. None of her drugs have changed from 2016.

 She can afford her co-pays of $180 per month that she pays at the pharmacy. The monthly Part D statement says the prescription drugs’ cost is $950 per month. I’m confused.

 Please give me some ideas to help control this cost!

Thanks,

Jennifer from Dallas, TX

 

Jennifer:

Your mother’s prescription drug problem is a typical problem since the cost of brand name prescriptions has risen dramatically.  She can afford her $180 co-pays, BUT… has no idea that the true cost of her prescription drugs is $950 each month.

Once her Medicare Part D prescription drug plan and the co-pays she pays total $3700 for 2017 for her covered drugs, then she is in the famous “Donut Hole” or coverage gap.

She must pay the next $4950 to get out of the “Donut hole”. She 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 she enrolled in.

What happens if your brand name drug is not a “covered” brand name drug on your specific Part D plan? You will have to pay 100% of that brand name drug.

Generics cost less, and for 2017, the cost is a 51% co-pay when in the “Donut hole”. Many brand name drugs do not have a generic alternative to use.

That is why it is important when choosing a Medicare Part D prescription drug plan, whether beginning Medicare for the first time or during Fall’s Medicare’s annual enrollment, to be sure all prescriptions are covered on one’s Part D plan.

Do research prior to enrolling in a Part D plan because if you choose the wrong plan, you cannot change it until Medicare’s annual enrollment period, which is from October 15th to December 7th every year.

January 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and different costs, deductibles, and a new Donut hole.

Toni’s Tips to help you stay out of the Donut Hole or not get in it as soon!

  • Visitmedicare.gov when selecting a Medicare Part D plan, whether it is your first time or changing during Medicare’s Annual Enrollment Period in the fall. This is an accurate way to view the cost of drugs and which plan and pharmacy are most cost effective.
  • Talk to your doctor or doctors about which brand name drugs can be changed to generics.
  • Get samples from your doctor.
  • See what generics are in a $4 or $5 generic prescription drug programs at HEB, Wal-Mart, and Costco etc.…  Pay for the generics out of your pocket.  To get their discounted price, you only need a prescription from your doctor.
  • Contact the Prescription Assistance Program in Lake Jackson at 979/285-1430, which has saved over $64 million dollars helping people get their prescriptions at affordable prices when they can’t pay for them.
  • Sign up for Toni’s newsletter and receive a free copy of the new Medicare Prescription Drug Survival Guide e-book version at www.tonisays.com.

Toni King is the author of Medicare Survival Guide available only at  www.tonisays.com and not sold in bookstores.  Email questions to info@tonisays.com or call 832/519-TONI (8664). ©

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