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.
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.
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.
Find an agent to get you the best coverage. Mom might need and "advantage" plan - only an agent (you don't pay the agent) can tell you which plans will be best for Mom.
Currently, I am not on any medications so I can afford to take the cheapest drug plan available. Should this change in the future, I will have to pay more to get more. I call my agent (at his request) in the beginning of November every year and he looks up my needs and finds me the least expensive plans. But his first question is always, what drugs are you currently taking.
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).
Check into the RX plans from united health or any medicare insurance company. My rx plan is only $33 a month. It has helped me out a lot. Then I have a supplement plan also, but if she only needs the rx, maybe you could go with that.
I had a dismal experience with AARP's United Healthcare - I started with another company, but changed for a year because United Healthcare was less expensive... Horrible service, deceptive charges, expensive drug costs - I changed back to my first company and will never again trust AARP's sponsorship!
Sometimes contacting the pharmaceutical company directly has reaped positive results in that the company itself will offer some financial assistance... It's always worth a phone call... Follow the statement "If I don't ask, the answer is always no"
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.
Agree with others to contact pharmaceutical company - you can do it online to see their income limits and eligibility guidelines. You can also check discount drug programs like GoodRx to locate the best cash price in your area. There are several, so do a search for discount drug programs. (You can even use these programs for pet meds if you have your vet write a prescription for you)
In addition to requesting assistance from the pharmaceutical company's patient assistance program (if any) try goodrx.com or rxsaver.retailmenot.com/. There may be others as well but I frequently get lower prices with these than I would using my insurance. Lowest pricing varies on different drugs so check each site. Best help is pharmaceutical assistance program for the really pricey meds, if she qualifies. Best of luck.
I had the Dr. rewrite my moms scripts and sent them to Canada Drug Co. It was so much cheaper. For a Dr. who won't cooperate we do have a Dunedin Meds of Canada. Dunedin is a town near me in Florida. I had a friend from North Carolina get her meds there after a surgery she had and she saved over half.
I've used the Canada Drug Company; I liked them. The insurance I use have this silver sneakers program and I can request a 90 day supply of meds sent to my home at no charge. You have to be 65 or older, that's the catch
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.
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.
Have you checked with your state's area agency on aging? My state (Pennsylvania) has a program called Apprise which assists seniors with medication coverage issues. The drug manufacturers also have financial assistance programs or rebates. Plus there are websites such as goodrx.com. You can google prescription assistance programs and more should appear. I would try to have the physician prescribe generic medications if possible. Lastly, perhaps the physician should review your mom's medications. Many seniors are receiving too many medications for their needs. This overprescibing can not only result in side effects, negative drug interactions and falls. A study indicated that if a senior is taking more than 7 medications, it could be problematic.
I didn't have much luck with Canada prices myself. Found better deals with Goodrx, other similar discount sites, Costco and Sam's. I price shop all of these before using insurance and save quite a bit - for people and pets.
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.
Some pharma companies have a special assistance program for when you are in the donut hole. You have to be below a certain income letter. Name brand drugs have phone numbers far patient assistance. Call that number and explain you are in the donut hole
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.
Request the Extra Help program from Social Security. If she meets the income guidelines it will be a judge help for her. Call the Social Security office in her area.
Go generic and try Walmart. Walmart has a lot of generics on their $4 plan. When mom fell into the donuthole I had the doctor write out a generic script and by doing that it was cheaper out of pocket than the copay for the brandname. Even after she got out of the donuthole I kept her on the generic. The only difference is that we have to give her two pills a day instead of one. With all the pills she takes anyways, it doesn't matter.
Hmorris Since you posted, have you tried any of the suggestions? I know the one I posted has helped my aunt. We learn from one another so please let us know what works for your mom.
There is an app called GoodRX. I tell everyone about it. It brought down the price of one of my dad’s Alzheimer meds from $500 to $30. You can adjust the dose and amount of pills in the app also. when my mom had pancreatic cancer there was a specific pharmacy downtown Charlotte that offered major discounts to cancer patients and others also.
If your mom has limited income, the big drug manufacturers (or at least some of them) have assistance programs. For example if you google "Pfizer help for low income" you'll find a link to Pfizer Pathways.
My family did this for my grandparents several years ago and it was pretty helpful. However the process is tedious because you have to contact each drug manufacturer individually. Your mom is lucky to have you helping her!
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.
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.
Find an agent to get you the best coverage. Mom might need and "advantage" plan - only an agent (you don't pay the agent) can tell you which plans will be best for Mom.
Currently, I am not on any medications so I can afford to take the cheapest drug plan available. Should this change in the future, I will have to pay more to get more. I call my agent (at his request) in the beginning of November every year and he looks up my needs and finds me the least expensive plans. But his first question is always, what drugs are you currently taking.
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).
Follow the statement "If I don't ask, the answer is always no"
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.
Since you posted, have you tried any of the suggestions?
I know the one I posted has helped my aunt. We learn from one another so please let us know what works for your mom.
when my mom had pancreatic cancer there was a specific pharmacy downtown Charlotte that offered major discounts to cancer patients and others also.
Certainly worth making a few phone calls to see if they can help you.
My family did this for my grandparents several years ago and it was pretty helpful. However the process is tedious because you have to contact each drug manufacturer individually. Your mom is lucky to have you helping her!