Medicare Part D has been a blessing for many seniors who are on a tight income and have a limited budget to spend on prescription medicine. The Medicare Part D coverage gap for those seniors who have a lasting condition, can be very difficult. By the end of the second quarter of the year you hear a lot of talk about the coverage gap or donut hole. How does it work, what is it, and why is it there? How does it provide prescription drug help?

To decrease the cost of Medicare’s Part D coverage, the coverage gap was created. Each year, a limit for Part D is determined. The yearly limit in 2007 was $2400.  The annual limit was increased in 2008 to $2510. In 2009 the amount is $2,700. The amount is calculated on the total costs of the prescripion drugs that you receive. What the insurance company pays and your co-pays are included in this calculation. For instance, if a prescription drug is $550 and the recipient pays $50 and the insurance company pays $500, the amount that goes towards the yearly limit is the full $550

While in the coverage gap, you must pay for all of your prescriptions 100%. Many Medicare Part D plans provide generic drug coverage when you are in the coverage gap. This really isn’t that much of a benefit because these Medicare Part D plans tend to cost more per month than most generic drugs actually cost. It might be worth it to have prescription coverage for generics for some patients because everyone’s situation is different.

In just a few months a Medicare Part D patient with chronic conditions can be in the coverage gap due to their expensive prescription drugs. We have witnessed patients reach the donut hole or coverage gap as early as February. Steering people to buy cheaper prescription medications when possible is the reason for the donut hole. This punishes those patients who must use costly prescription medicine because nothing else works.

Enbrel is a medication for people who have rheumatoid arthritis and the high cost of it can cause the patient to go into the donut hole within 2 or 3 months. The option at this point is to pay for the prescription at full price for several months until the catastrophic coverage portion kicks in or suffer the potentially disabling consequences of stopping their prescription medication. The price of Enbrel is about $18,000 per year. There are many senior citizens who are not able to afford for that.

Due to their lower income level, some patients will be able to take advantage of patient assistance programs.

One of the best ways to get low cost or free prescriptions is to talk to the drug companies. Call the company and ask about their Prescription Assistance Program.  Almost all drug companies offer these programs, which enable patients to receive drugs they need at a price they can afford.  A lengthy application co-signed by your healthcare provider is typically necessary for entry into the program. Patient Assistance Programs run by manufacturers have been in existence for over 15 years. These programs are designed to assist eligible individuals who can’t afford their prescription medicine due to limited income or other financial hardships.  Pharmaceutical companies did not want their low income patients to be forced to make a choice between paying for life saving prescription medicine 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. Often times multiple applications had to be filed. Please do your research and get the help with prescriptions that you need.