Follow
Share

What do you do when your loved one reaches the Medicare "donut hole" on medications and cannot afford to buy his meds?

This discussion has been closed for comment. Start a New Discussion.
There are many organizations that can help with med costs. Try the RX Outreach website. It does not matter about whether a person is on Medicare, Medicaid, etc. with this program. Even people who are not old enough for Medicare can get meds at a very reasonable cost.
(0)
Report

I found a company that helped by doing all the paperwork required by the drug companies' assistance programs. As Carol mentioned, it can take some doing to navigate the paperwork, etc that the assistance programs require to qualify so it's a great service to have someone do it for you. It worked for us while in the donut hole; it's worth a shot.
(0)
Report

My friend just nudged me to remind you all that not all pills should be cut in half due to absorption rates and some generics don't provide the same theraputic range - - anything you plan to do please discuss consequences with your doctor. You can't assume that they will remind you. Always ask to be sure.
(0)
Report

be direct with the doctor & ask for samples of the meds that are most expensive every month. Most doctors are on your side & will help if you ask. they want to see their patients stay healthy.
(0)
Report

Hmmm...here might be an idea. Usually double amt. Rx's (ie, 100mg rather than 50) are not more expensive. Mom's doctor did this with Zoloft. Ordered double dose pills and we cut them in half.
(0)
Report

Depending on the drug manufacturer, some have programs for people who have Part D or other prescription drug insurance, especially if the patient is in the gap with Part D. It takes some searching but if you go into the website for the drug you need, find the manufacturer, and go into that site, you will find info to help. If not, call the manfacturer . If have done it and have save enough on my Mother's medications to keep her out of the gap. I just don't understand WHY there is a gap!! I dont know of any other prescription drug coverage that has one. Another way to discrimante against the elderly???
(0)
Report

There is a program called Rx Outreach that you can access online. It lists medications that you can buy at a low cost. You can also find out the name of each drug manufacturer, go online to the manfacturers website and probably find a program to help get the meds. A lot of the manfacturers will still take applications from patients who have Part D if their income is below a certain level. It is time consuming to fill out the apps, get new prescriptions, etc. but since any meds you get from the manufacturer or other programs do not count on the Part D coverage, you can avoid the donut hole. Good luck with this, I have been doing this with my Mothers meds and have been able to avoid the gap and she takes a lot of medicine!
(0)
Report

Here's what happens to my 99-year-old mother with the donut hole. She is in an assisted living facility. They dispense her meds. They use a separate pharmacy entity to maintain her prescriptions, obtain them from (themselves), and they put them in little organizers or packets or something for each day's dosage, etc. They do not have a bargain rate for the prescriptions. She has even had her OTC meds taken from her, and is not allowed to obtain any prescriptions on her own. If she wants to obtain her own prescriptions, she must go get them herself and pay a fee for each prescription to be introduced into their "system" which often exceeds the original price of the prescriptions themselves. Even samples that the doctor tries to give her are confiscated and destroyed. Therefore, she hits the donut hole pretty early in the game. There is no logic to be argued here. This is the way they do it at this place. Everybody gets a piece of her pie. they point out that this was part of the contract she signed when she entered, and that these policies are for her own safety and to protect the staffers. She has nearly run out of her life savings, despite the fact that she never spends a nickel on herself. Monthly resident fee is over $3200. If anyone has some insight on this situation, I'd be glad to hear it. In a separate issue, I have described our life under Home Health, as my husband is a quad. We live hundreds of miles from my mother. I cannot go to or help her. Breaking my heart.
(0)
Report

With Medicare D, once you reach a certain amount on your coverage, there is a time where you must foot the full bill (rather like meeting the deductibles on other health insurance). After that amount is satisfied, then Medicare kicks in again. This "donut hole" is a disaster for many elders with expensive medications that can cost hundreds, if not thousands a month.

There has been an outcry about it, but it has yet to change.
Carol
(0)
Report

I guess I am in the dark on this one.... I do not know what you mean by "donut hole"/ empty prescription fulfillment.
If you have Medicare Part D, it should suffice for all generic and some non-generic medications. Does it not? There is a small $3.00- $8.00 co-pay, but surely that is not your problem, is it?
Some medications are not approved by Medicare Part D, at all, and therefore are deemed unnecessary to your health. For example, Retin A is not allowed by Part D, and therefore must be paid for out-of-pocket. Tell me what you men by this so-called "donut hole".
(0)
Report

I tried to get to the website junebug recommended and all web searches came up with nothing. Help!!!
(0)
Report

Junebug,
Sounds great. Hope this is an answer to your prayers. What is Viva Medicare Plus????
(0)
Report

I have just got educated about that black hole call, donut hole. After alot of praying, my answer came. VIVA MEDICARE PLUS

I LIVE IN ALABAMA but, THEY WILL HELP YOU FIND HELP IN OTHER STATES, maybe. hope this helps, if so,give praise to GOD!
not me.
(0)
Report

I live in NJ, and we have something called Senior Gold and Padd. I don't know if it is the same in other states, but it is very helpful. Mom had Senior Gold and had about a 50% discount rate in scrips. It was based on her income. They did not care about a trust or any assets that were not in her SS#. Now that dad is gone, she qualified for PADD. They signed her up for Medi.part B and pay the premium. Her income dropped due to getting only one SS check a month. She pays about 7.00 for each months amount of each scrip. We have not hit a limit yet and not sure if there is one. I don't know what she would have done without this great program. I should not speak too loudly. Whenever you get a good thing, someone takes it away! Do other states have such a program?
Linda
(0)
Report

Thank you txmaggie. I will talk with my patient about doing this. We are visiting the possibility of changing his Parkinson's meds anyway. Hopefully he will be switched to generics that he can pay out of pocket. He also takes plavix and opted to stop taking it because of the price.
(0)
Report

Last year we hit the donut hole in November, and some of mom's meds are prohibitively expensive. She has medicare and the AARP supplemental insurance. This year I am trying a different route. I asked the dr to order the prescriptions to fit Walmart's generic drug plan. Some of the more common meds are less than $8/month and I've been filling these by just paying out of my pocket. It keeps them off the medicare/insurance plan. Even though your insurance may only charge you a very small co-pay, they are still charging the full amount to medicare, and hence you get in that darned donut hole. By avoiding the medicare charges, I've kept her drug expenses way down, so she will will be able to fill the expensive, non-generics (like Plavix) through the rest of the year and not hit the donut hole. I read about this in the AARP publication and it's working for me.
(1)
Report

I thank you both for your comments. However, I have been reading up on this. Most patients on medicare do not qualify for the programs offered by pharmaceuticals. That does not seem fair.
(0)
Report

All great advice, MK! I was going to suggest going through the pharmacist for the drug company and their programs. Some do help, believe it or not, but it takes some doing. But yes, make as much noise as possible.
Carol
(1)
Report

We have a doctor who plans to continue prescribing a couple of prescriptions for our care. He has shown particular interest in keeping us well-supplied in case he increases the dosage of the prescription. Therefore, I think he might be willing to request a greater number of pills, again in case he increases, and that might help us stay supplied for a longer period. Also, I know that some manufacturers have programs where they have special pricing for individuals who have trouble paying for needed prescriptions. Aside from that, Medicare has resources, as do county and state organizations. In other words, yell "HELP!!!" With any luck at all, that nonsense aspect will be eliminated soon.
Congressmen, senators, etc., need to hear of specific cases, include your photo! asking just what are people supposed to do? We've stayed silent too long, and now these officials are sort of surprised at the upsurge of outspoken seniors who are out of patience.
(1)
Report

This discussion has been closed for comment. Start a New Discussion.
Subscribe to
Our Newsletter