Medicare Part D Prescription Drug Coverage
Medicare drug plans have a “coverage gap,” also referred to as the “donut hole.” This coverage gap begins when you and your plan have spent a total of $2,830 for covered medications (this total is calculated by adding the co-payment you have paid to the amount the plan has paid for the medication). At this point you will then pay, out-of-pocket, the full price of your medications until you have spent $4,500 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 programs may reduce the costs for Medicare Part D beneficiaries for deductibles, copayments, premiums, and, most importantly coverage during the gap. Other programs, such as patient assistance programs through the drug companies that make the medications can help. Also can help lower medication costs during the gap, especially for individuals with chronic and severe illnesses and conditions. Other strategies, such as using a mail order program, visiting a pharmacy with lower prices, and reviewing your medications for lower cost alternatives, may also help to lower monthly prescription costs.
MCPHS Pharmacy Outreach staff can review your information and list of medications to see what programs and strategies can be used to help you. Pharmacists at MCPHS Pharmacy Outreach can also review your list of medications to make recommendations on how you may work with your doctor to discuss lower costing, alternative brand name medications or generic medications.