Medicare Part D and Enbrel
Monday, August 31st, 2009 Subscribe To Our Feed
On a limited budget many seniors on a tight income have very few dollars to pay for their medicine. The Medicare Part D coverage gap for those senior citizens who have a lasting illness, can be tough realization. The donut hole or coverage gap is often talked about at this time of year. How does it work, what is it, and why is it there? How does it provide prescription drug help?
To reduce the cost of Medicare’s Part D coverage, the coverage gap was created. Each year, a limit for Part D is determined. $2400 was the 2007 yearly amount. $2510 is what the annaul limit was increased to in 2008. $2700 is the amount in 2009. determination of the limit is based on the total cost of the drugs that you receive. This includes your co-pays and what the insurance company pays. For instance, if a prescription medication is $550 and the insurance company pays $500 and the patient pays $50, the amount that goes towards the annual limit is the entire $550
You must pay for all of your prescription medication 100% during the time you are in the donute hole or coverage gap. There is coverage for your generic drugs when you are in the donut hole or coverage gap. The cost of most generic drugs is so small that the benefit of having them covered by a Medicare Part D plan is not that much of a benefit. For many people it might be worth it to have prescription coverage for generics, everyone’s situation is different.
Chronic conditions which often require costly prescription medicine for treatment result in Medicare people reaching the coverage gap in a matter of months. Reaching the coverage gap as early as February is not uncommon. Steering people to buy less costly prescriptions when possible is the reason for the donut hole or coverage gap. This punishes those people who must use high priced prescription drugs because nothing else works.
Patients whose rheumatoid arthritis is successfully controlled by Enbrel can reach the coverage gap within 2 or 3 months because of the price. Halting their medication which has potentially disabling consequences or paying for their medicine at full cost is often the only option available to these people. Roughly $50 a day is what Enbrel costs. There are very few seniors who can afford that.
Patient assistance programs can assist those applicants who qualify.
Going directly to the drug company can be most 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 consumers to receive medicine they need at a price they can afford. You and your doctor will need to complete an application. Patient Assistance Programs run by drug companies have been in existence for over 22 years. These programs are designed to assist eligible patients who cannot afford their 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 prescriptions 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 these programs or could follow the complicated application process that was necessary for participation. Often times multiple applications had to be filed. Please do your research and get the help with prescriptions that you need.
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