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Seniors in Donut Hole to get 50% off of RX meds

May 26, 2010 By 1 Comment

May 25, 2010 – The Centers for Medicare & Medicaid Services (CMS) has issued new guidance to Part D plan sponsors to guarantee that senior citizens and other Medicare beneficiaries enrolled in Part D prescription drug plans will see 50 percent savings on their brand name and some authorized generic drugs when they enter the coverage gap, or donut hole, during 2011.

In a notice in the Federal Register, CMS also issued the draft model agreement that drug manufacturers of applicable Part D drugs will sign in order to participate in the discount program.   These agreements with manufacturers represent an unprecedented partnership to help millions of Medicare beneficiaries. Discounts will apply when the beneficiary reaches the coverage gap.  Eligible beneficiaries will see the discount when they buy their drugs at their local pharmacy counter.

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Medicare’s Coverage Gap: Seniors and families feeling a big bite in costs

August 24, 2009 By Leave a Comment
Pharmacy Rx symbol
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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.



Watch CBS Videos Online

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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Minority Seniors Affected by Lack of Prescription Drug Benefits

August 5, 2009 By Leave a Comment

by Rose Broyles

With rising prescription drug costs, Americans continue to scramble and find ways to pay for medication. With the Obama Administration currently tackling  monster healthcare reform, seniors can only wait around to see how this all turns out. Meanwhile, they will either have to continue paying what they can, order from other countries like Canada for cheaper drugs, or forego some medications altogether; this is something that many, including healthcare experts, are concerned about. So how does this affect minority seniors?

According to a study from the San Francisco Veterans Affairs Medical Center,  African American and Hispanic senior citizens who lack prescription drug benefits are three times more likely than white seniors to cut back on taking their medications. What were their findings? It looks like there wasn’t anything conclusive, but it seems that there is more than just the issue of money.

“Forgoing medications for lack of coverage is a very real phenomenon. This study calls attention to the magnitude of this problem, particularly among certain disadvantaged communities,” said Michael Steinman, MD, a fellow in the VA National Quality Scholars Program at SFVAMC and University of California, San Francisco.

Ethnic Differences or Income Level?

The researchers interviewed about 5000 people over the age of 70 for their study about:  income, assets, insurance coverage, monthly prescription drug costs, and their ethnicity. 80% of the seniors without coverage said they cut back on their medication. The contributing factors for the medication cutbacks included: low income, high out-of-pocket costs for prescription drugs, and African-American or Hispanic ethnicity. 21% of African Americans and Hispanics had restricted their medications.

“Our data suggests that among minority seniors with low income and high drug costs, as many as 43 percent of people without coverage could be restricting their medication”

Even with the fluctuation of medications and income levels, African Americans and Hispanics were still likely to cut back. Steinman states that attitudes about how they spread their resources may be different across ethnic lines.

“If you have a limited amount of money each month, and you have to pay for medicine, food, telephone service, and rent from that, then in some cases not taking your medications is an understandable choice”

Final Analysis

I found this to be an interesting study.  I remember as a Sociology minor, we would analyze group dynamics and cultural shifts and attitudes about certain issues. This probably would have been one of our topics. Is there really that big of a  difference between minorities and caucasians when it comes to taking prescription drugs? I’m not so sold on that. I think that finances have a huge impact on whether or not the senior will take certain drugs or not. I think that above all else, money or lack thereof, is the contributing factor. While I agree to some extent, that one’s culture (more so than ethnic background) may affect their decisions, if a senior is assimilated to the way of life in this country, or their state, even city for that matter, I don’t think it makes all that much difference. It just depends on how proactive they, their family and their doctor are with regards to their health.

My dad for instance loves his doctor. His doctor is really good. He’s one of a few doctors who actually take a proactive approach to care. He doesn’t just give Dad a prescription without explaining to us its risks and if he doesn’t feel that the drug will help, he will not prescribe it. There has to be a compelling reason behind why he’ll give Dad a drug. So, obviously Dad listens to what his doctor suggests. Medications cost alot, but if Dad knows that what he is taking is good for him, he’s going to take it. Dad’s not white, we’re not white. We’re not rich either. So, does the minority argument hold? No, neither is the income level in our case.
Truth of the matter is, seniors who tend to be more educated and informed of their conditions will take their medicines. They’ll find ways to save money if their resources are limited. So I’d say that this one is still up in the air!

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