Part D And Enbrel

For most seniors who live on a tight income, Medicare Part D has been an answer to their prayer. However, for those senior citizens who have a lifelong illness, the Medicare Part D -donut hole- can be a real shock. The donut hole or coverage gap is often talked about by the end of the first quarter of the year. What is it, why is it there, and how does it work?
To decrease the cost of Medicare’s Part D coverage, the coverage gap was created. The yearly limit for Part D is set each year. The annual limit in 2007 was $2400. The yearly amount was increased to $2510 in 2008. The amount is $2700 in 2009. The limit is calculated on the total costs of the prescription medicine that you receive. This includes your co-pays and what the insurance company pays. If the insurance company pays $500 and the recipient pays $50 for a prescription, the amount that goes towards is applied to the annual amount is the entire amount of $550.
While in the donut hole or coverage gap, you are responsible for all of your prescriptions out-of-pocket. There is coverage for your generic drugs when you are in the donut hole or coverage gap. This really isn’t that much of a benefit because these plans tend to cost more per month than most generic drugs cost. For some people it might be worth it to have coverage for generics, everyone’s situation varies.
For Part D patients with chronic health conditions which often require costly medicine for treatment, the donut hole can be reached in a matter of weeks. Reaching the donut hole as early as February is not uncommon. Encouraging people to use less costly medications when possible is the whole point for the coverage gap. That is fine for those people who have that option but it punishes those who must take expensive medicine because nothing else works. Enbrel is a medicine for patients who have rheumatoid arthritis and the cost of it can cause the patient to go into the donut hole or coverage gap within 2 or 3 months. Halting their medicine which has potentially disabling consequences or paying for their medication at full price is frequently the only option available for these patients. The cost of Enbrel is approximately $50 per day. There are a lot of senior citizens who are not able to pay that.
Qualifying for patient assistance programs can help some lower income patients. The best way to get low cost or free medicine is to talk to the pharmaceutical company. Call the company and ask about their Prescription Assistance Program. Almost all pharmaceutical companies offer these programs, which enable people to receive medicine 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 drug manufacturers have been in existence for over 16 years. These programs are designed to help eligible individuals who can’t afford their drugs due to low income or other financial hardships.
Drug manufacturers did not want their low income patients to be forced to make a choice between paying for life saving 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 necessary for participation. In many cases multiple applications had to be filed with several different drug manufacturers in order to gain access to a PAP.
The manufacturers think that offering information on their websites and toll-free numbers is all that patients need to access PAPs. They just don’t understand the inability of many patients, particularly those on several medications from 2 or more physicians to follow through with the fragmented application process. It also places an unfair burden on the physicians that are already overburdened with paperwork. Fortunately there are companies that will perform the task for patients for a fee. These prescription assistance companies will generally coordinate the process from beginning to end. Of course the prescriptions are free and if people can do it themselves they should, but for those patients that just do not have the skills to do it themselves, the hiring of a organization to do the job is a better option than not taking the prescription drugs they need.