Medicare Part D Prescription Drug Coverage
Medicare drug plans have a built in “coverage gap,” also referred to as the “donut hole.” The coverage gap starts when a patient and their Medicare drug plan have spent a total of $2,830 for covered medications. This total is calculated by adding the co-payment paid by the beneficiary to the amount the drug plan has paid for the medication. During this “donut hole/coverage gap”, individuals must pay, out-of-pocket, the full price of their medications. The gap ends once the Medicare beneficiary has spent $4,500 in medications for the calendar year. Every Medicare prescription drug plan has a coverage gap.
There are a few programs and strategies that can be used by seniors to help reduce the costs of medications while in the coverage gap. The programs that provide the best assistance are Medicare’s Extra Help and Prescription Advantage. These two programs reduce the costs for Medicare Part D beneficiaries throughout the year for deductibles, copayments, premiums, and most importantly they provide coverage during the gap. Other programs, such as patient assistance programs through the drug companies that make the medications, can help. Also, co-pay assistance foundations can help lower the costs during the gap. Other strategies such as using a mail order program, visiting a pharmacy with lower prices, and reviewing your medications for lower cost alternatives can also help to lower the costs of monthly prescription costs.
MCPHS Pharmacy Outreach staff can review your client’s information and list of medications to see which programs and strategies can be used to help. Pharmacists at MCPHS Pharmacy Outreach Program will review the list of medications and make recommendations for the client to discuss with their physician or health care provider, such as using alternative brand name medications or generic medications.
For additional information, call the Pharmacy Outreach Program at 1-866-633-1617.