by Rose Broyles

This is the predicament we are currently in. In fact, I just had to make a call to my dad’s doctor today to see if there is a lower cost alternative to Advair, the drug my dad needs to control the symptoms of his COPD and asthma. But before I get into all of that, what exactly am I talking about?

What is the Medicare Coverage Gap?

There was a story showcased on CBS Evening News regarding the Medicare Coverage Gap or “Doughnut Hole” back in 2006. Unfortunately, nothing has changed to alleviate the problem of Medicare Coverage Gaps.

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While the debate rages on in this country about how much the government needs to get involved in healthcare, people like my dad are seeing their only means of living depleted by high prescription costs. You see, my dad reached the threshold for the amount that Medicare will pay for his medicines. He does have Secure Horizons but they have already paid out their share and so Dad is responsible for the rest of his. At least, this is what the representative told me on the phone. Health insurance is so confusing!

Regardless, what was $30.00 for Advair is now $200.00. This price is for one medicine! Don’t forget, we also have all of Mom’s prescriptions, some of which cost around the same price without additional help from insurance.

Options to Consider

While I wait for Dad’s doc to get back to me on other generic alternatives, I’m trying to find other ways for us to afford these medications until January when everything resets and Medicare covers everything again. Medicare Interactive has a list of suggestions to follow if you fall into the “doughnut hole” . You can read more about the details of each, but I will summarize the suggestions below.

1. Ask your doctor
2. If you have extra help, find out about a mail order option.
3. Request that your loved one’s  plan put your drug in a lower “cost tier” . This will require a formal request from the primary care doctor. Ask them to put your loved one’s plan and ask for an “exception” to the formulary.
4. Some pharmacies and hospitals will waive copays for people with low incomes
5. Some states offer pharmaceutical assistance programs that help their members pay the out-of-pocket costs of a Medicare private drug plan.
6. Some charities may pay a portion or the full cost of your Medicare prescription copays.
7. Catastrophic coverage.
8. Some pharmaceutical companies have Patient Assistance Programs (PAPs) that offer low-cost or free drugs to people with low incomes.
9. Lower price at the pharmacy.
10. Prescription drug discount programs. You can try a place like http://www.needymeds.org/drugcard/index.shtml to see if you can get big discounts on prescriptions.

***I’m going to add another suggestion here which we in fact, are going to try if his doctor can’t give us a good generic that’s affordable. We’re going to ask him if it would be ok for us to order from Canada and get a prescription. Canada follows a very strict quality control of medicines in the same way that the FDA does for us.

Therefore, their drugs are of high quality and safe to use. Advair is on sale for $249 for a 3 discus pack as opposed to around the same price at CVS for one.

This is also the actual brand name. So, this sounds like a great deal. There are of course, a ton of other drugs available of up to 80% cheaper than the drugs you will find here. Now, not to say that we couldn’t just drive across the border to Mexico to get prescriptions (I know some people who do) but I feel more comfortable ordering from Canada because of their stringent standards.  Now be careful of just ordering from any online pharmacy that claims to be Canadian. You have to make sure they are the real deal. Since we are partnered with Canada Pharmacy.com and will be ordering from them ourselves, they are verified by pharmacychecker.com and certified by the Canadian International Pharmacy Association . The seal itself isn’t a guarantor of authenticity so you should directly go to CIPA’s website and manually enter the pharmacy name in their search box.

So, as another challenge presents itself to us, Dad has to forgo this important medication for a couple of days while we figure things out. What happens though to the millions of other seniors who do not have family to help them? This is where I feel people should put their politics aside and at least, regardless if we have a nationalized healthcare system or not, consider the most vulnerable of our nation–seniors and children. They should be attended to, if not everyone else. This is a prime example of why our healthcare system needs serious reform.

**Update: Later today we got a call from Dad’s doctor’s office. Tomorrow we will have to pick up samples! So there you have it, it was option 1 from above! This is only a temporary fix so I still have to see what else we can do. It looks like we will end up getting some meds through Canada.

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