annesims1 Asked September 2011

What can I do if my dad maxed out his prescription coverage?

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he is 88 years old and in good health. has macular degeneration and takes meds for bp and heart with a few others. his ins states he has maxed out on his presription coverage. he has an income but can not afford all the bills for living and now meds. we took him to the va as he was in the army. they are trying to see if he qualifies. it is taking a long time . the dr office has been sending samples of some. adivar for his asthma etc. what can we do

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EXPERT Carol Bradley Bursack Sep 2011
I saddens me no end when people can't afford their medications. I'm so sorry you and your dad are going through this I can't put it into words.
I'm wondering what kind of insurance he has. If he is on Medicare, and has Medicare D, he maybe has reached the coverage gap, but once he's through it, the insurance kicks in again (this is a bad deal and is gradually going to be fixed, but it is how it operates at this time). If he had other insurance, it sounds to me that you are doing all you can for him, but it's outrageous that he can't get the medication he needs. The VA will help eventually, but it does take a long time to process his paperwork. Please keep working with the doctor and the drug companies and keep us posted on how you are doing.
Carol
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jeannegibbs Sep 2011
I was in the "donut hole" of no coverage last year, and the doctor's office gave me cards that were intended to reduce the costs of 2 expensive drugs. When I brought them to the drug store I was told that I couldn't use them -- they were strictly for people who had no insurance coverage. The fact that my insurance was, in effect, not applicable, did not matter. The pharmacist was very sympathetic but said they would get into a lot of trouble if they accepted the discount card.

Whoever dreamed up the "donut hole" coverage, and what were they smoking at the time?

We may have the best medicines in the world but our drug distribution system is outrageous.

I often think of the Dicken's story, A Christmas Carol, where lame Tiny Tim was going to die until he got help from a wealthy benefactor. It is sobering to think that working people in the US today are often like Tiny Tim's family -- unable to pay for medical care they need.
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TheFixer Sep 2011
Both Walmart and Target have a $4 prescription drug program (Many grocery stores also). I think it's just for generics, Walmart's site lets you type in the name of the drug to see if it qualifies. Also K-Mart has a prescription dug program, it's $10 to join has $5 generics with discounts on name brands. Good Luck!
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I have seen commericals on TV for drug companies that offer help if you can't afford prescriptions. I know for a fact that some drug companies do help. Someone I know thru my mother got help. Her husband worked and had good insurance. But the medication she needed the insurance wouldn't cover. She contacted the drug company and she was able to get her medication at a discount price. So maybe check into something like that you never know unless you ask.
In Pa, there is a program that helps with cost of meds if you meet the income guidelines it is sponsered thru the lottery. Maybe you can find a state program.
The Va take a long time to go thru. I waited 8 months only to find out that mom wasn't approved. My dad served but it wasn't during specific war time dates so that disallowed her. But on a positive note if your dad is approved he should get all that back pay from the time he applied from my understanding.
It is ridiculous the cost of meds. With my mother's dementia and related symptoms and my husband and his severe diabeties, and all his other meds. It costs this household a small fortune each month just in co-pays. Now mom is on Hospice and they cover most. So that is a little extra pocket change.
I am sorry that I can't give you a fixer to the problem. Just research there are programs out there but finding them is the problem.
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