Donut Hole

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

19 Comments

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.
3930 helpful answers
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
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.
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.
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.
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
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.
Junebug,
Sounds great. Hope this is an answer to your prayers. What is Viva Medicare Plus????
I tried to get to the website junebug recommended and all web searches came up with nothing. Help!!!
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".

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