I, for one, would like to force whatever congressman who came up with this idea to have all of his family fall into a donut hole and never be seen again. You get hit with having to pay Medicare, and then you have to have a supplement to cover what Medicare does not pay, and then they hit you up for even more money if you get the part D coverage for meds. Sorry if this does not really fit here, but it seems they are out to take every dime we get from Medicare back with all sorts of charges. Sad way to treat people, especially those who are limited on their income. Keep looking for help with the meds, and let us know.
Perhaps it's time to speak with her doctor about whether or not she needs to be on those medications. Discuss ways in which your mother can taper off medications safely. And ask about cheaper generics, or older drugs that might be both cheaper and acceptable substitutes.
If a name brand has a generic, the insurance company will require you to use the generic. The only way you can get a brand name is if there is no generic or the doctor tells the insurance company that the patient can only use the brand name.
Medicare is not the problem, its the prescription plan you have chosen.
Every state is different which Medicare suppliments are allowed to write policies in that state , I suggest u contact your Office of Aging and ask if there is someone who can help you explore your options, Depending on Moms income, she may qualify for a State plan. In NJ its called PADD. Maybe even Medicaid. It may be for a little extra money a month her meds maybe cheaper.
If you end up going with GoodRx, make sure you go online and get a coupon for wherever you are going to get the RX filled. You find them on the GoodRx website.
GoodRx rocks. I was dubious and never had to use it since we have insurance. But then I needed meds for the dog. Dog doesn't have insurance. GoodRx knocked between 50-70% off the price.
These other responses are more informed than I am on this subject; all I have to add is to see if you can get a better price without insurance and with a coupon from goodrx.com. I’ve used it to save hundreds.
Also, in the long term, our prescription drug situation in the U.S. is completely untenable and the result of politicians being bought by pharmaceutical companies. We should all be voting for candidates who unequivocally support single-payer Medicare for All with coverage for prescription drugs and long term care (and that would be Bernie Sanders).
Your doctor. He gets 6% of a lot of prescription costs. Most dementia drugs are completely unproven as whether they help or they do not help. Other drugs that are costly have generic drugs that are old and work as well as the new ones. Tell the doc you need to review drugs and costs NOW as you cannot afford them.
Consider less expensive alternatives. My aunt started off with Aricept and then she was also prescribed Namenda. The Namenda was so expensive on her drug plan. So after searching on line I discovered there was an alternative. I contacted her doctor and asked for Namzeric which is a combo of aricept and Namenda and that year was less expensive on her drug plan than the two separate pills. Now it’s the opposite. The two separate pills are less expensive than the one combo. I was able to get 90 days supply of the two pills for less than only 30 days of the Namzeric.
My mother also has that problem. Mainly with her asthma inhaler. We called the pharmaceutical company and they sent her out paperwork that allowed her to get the medication for free from them. This happened every year. Now she is on generic and haven't had the problem.
bottom line: call the pharmaceutical company and ask for hardship program.
Ask your mom's Medicare Part D insurance co. and her physician to complete a "Tier Exception Request Form" for one or more of your mom's priciest medications. If the Dr. approves the "Tier Exception Request," the Part D insurer will most likely approve it as well. The Dr. explains on the form why the medication is an absolute must for the patient, and asks the insurance co. to move that particular med. from "Tier 4" to "Tier 3," or from "Tier 3 to Tier 2." Alzheimer's, cancer, diabetes, kidney and heart medications are among the most expensive prescriptions, and they are often classified as "Tier 4" in the formulary by the Part D insurer.
My mom's neurologist was able to get her Tier Exception Request Form approved fairly quickly, so now, I pay a $12.95 co-pay for a one-month's supply of Mom's Rivastigmine transdermal patches at Tier 3, instead of a $134.50 Tier 4 co-pay. co-pay.
which insurance company is this? Cigna Healthspring Part D has refused every Tier exception request I have submitted for mom. It's like a joke, you fill them out and they reject each one, like they didn't know they'd reject it at the time they suggest you complete the form. I'd love to know what insurance company actually approves some of these requests.
Every state is different which Medicare suppliments are allowed to write policies in that state , I suggest u contact your Office of Aging and ask if there is someone who can help you explore your options, Depending on Moms income, she may qualify for a State plan. In NJ its called PADD. Maybe even Medicaid. It may be for a little extra money a month her meds maybe cheaper.
Also, in the long term, our prescription drug situation in the U.S. is completely untenable and the result of politicians being bought by pharmaceutical companies. We should all be voting for candidates who unequivocally support single-payer Medicare for All with coverage for prescription drugs and long term care (and that would be Bernie Sanders).
https://www.medicareinteractive.org/get-answers/cost-saving-programs-for-people-with-medicare/the-extra-helplow-income-subsidy-lis-program/extra-help-basics
Also look up her prescription on GoodRX.
Consider less expensive alternatives.
My aunt started off with Aricept and then she was also prescribed Namenda. The Namenda was so expensive on her drug plan. So after searching on line I discovered there was an alternative.
I contacted her doctor and asked for Namzeric which is a combo of aricept and Namenda and that year was less expensive on her drug plan than the two separate pills.
Now it’s the opposite. The two separate pills are less expensive than the one combo. I was able to get 90 days supply of the two pills for less than only 30 days of the Namzeric.
Hope this helps.
bottom line: call the pharmaceutical company and ask for hardship program.
The Dr. explains on the form why the medication is an absolute must for the patient, and asks the insurance co. to move that particular med. from "Tier 4" to "Tier 3," or from "Tier 3 to Tier 2."
Alzheimer's, cancer, diabetes, kidney and heart medications are among the most expensive prescriptions, and they are often classified as "Tier 4" in the formulary by the Part D insurer.
My mom's neurologist was able to get her Tier Exception Request Form approved fairly quickly, so now, I pay a $12.95 co-pay for a one-month's supply of Mom's Rivastigmine transdermal patches at Tier 3, instead of a $134.50 Tier 4 co-pay.
co-pay.