On a limited budget a lot of seniors on a fixed income have little to no money to pay for their medicine. For those patients who have a lasting condition, it can be a tough realization when they hit the Medicare Part D donut hole. The donut hole or coverage gap is often talked about by the second quarter of the year. Why is it there, what is it, and how does it work? How does it provide prescription drug help?

To reduce the cost of Medicare’s Part D coverage, the coverage gap was created. The yearly limit for Part D is determined each year. The yearly amount in 2007 was 00.  10 is what the yearly amount was increased to in 2008. In 2009 the limit is ,700. The total dollar amount of the prescription medications that you receive is how the limit is determined. What the insurance company pays and your co-pays are included in this calculation. For example, if a prescription medication is priced at 0 and the insurance company pays 0 and the recipient pays , the amount that goes towards the annual limit is the entire 0

You are responsible for all of your prescription medicine 100% during the time you are in the donute hole or coverage gap. Many Medicare Part D plans provide generic coverage when you are in the donut hole. The cost of most generics is so small that the benefit of having them covered by a Part D plan is not that much of a benefit. For some people it could be worth it to have prescription coverage for generics, everyone’s situation is different.

For Medicare patients with chronic health problems which often require expensive drugs for treatment, the coverage gap can be reached in a matter of weeks. We have witnessed people get to the donut hole or coverage gap as early as February. Steering patients to use less expensive medicine when possible is the reason for the donut hole. That is okay for those patients who have that option but it punishes those who must use expensive drugs because nothing else works.

For example, for patients with rheumatoid arthritis whose health condition can only be successfully controlled by Enbrel, they can fall into the coverage gap within 2 or 3 months. The option at this point is to pay for the prescription at full cost for several months until the catastrophic coverage portion applies or suffer the potentially disabling consequences of stopping their prescription medicine. The cost of Enbrel is approximately a day. There are a lot of senior citizens who are unable to afford for that.

Due to their lower income level, some people will be able to sign up for patient assistance programs.

Going directly to the pharmaceutical company can be very helpful in getting low or no cost medicine. Call the company and ask about their Prescription Assistance Program.  Most all drug manufacturers offer these programs, which enable people to receive medicine they need at a price they can afford.  A lengthy application co-signed by your doctor is typically necessary for entry into the program. Patient Assistance Programs run by drug companies have been in existence for over 17 years. These programs are designed to assist eligible patients who can’t afford their prescription drugs due to low income or other financial hardships.  Pharmaceutical companies did not want their low income customers to be forced to make a choice between paying for life saving prescription drugs or for paying for rent or groceries.  As a result, patient assistance programs came into being as part of the company’s philanthropic efforts. Until relatively recently, few people knew about the existence of these programs or could follow the complicated application process that was required for participation. In many cases multiple applications had to be filed. Please do your research and get the help with prescriptions that you need.