Recent healthcare reform legislation gradually reduces what
beneficiaries must spend when they reach the Part D doughnut hole or gap in
coverage. Medicare consumers who hit the doughnut hole receive a 50 percent
discount on brand name drugs and a 7 percent discount on generics in 2011.
While that’s good news, don’t breathe any sighs of relief just yet. Seniors and
the disabled who hit the doughnut hole must still spend $6,448 in total drug
costs in 2011 before they reach catastrophic coverage period.
Here are six
steps to take now that can help you slow hitting the doughnut hole
1. Learn the full cost and coverage for every drug you take: If
you take more than $236 worth of prescription drugs a month, you’re at risk of
hitting the doughnut hole at some point during the year. The $236 is based on
the full retail cost, that is what you and your drug plan pay, not your
co-pays. Part D plan enrollees have an initial coverage limit of $2,840 in
total drug costs (what you and your plan pay) in 2011. You can learn the full
cost of your drugs and whether your plan covers all your prescriptions using the
drug using the Medicare Drug Plan Finder at www.medicare.gov.
2. Estimate your costs and when you may risk hitting the doughnut
hole: Based on the prescriptions you enter, the Medicare Drug Plan Finder can
estimate your annual costs and when you potentially may hit the doughnut hole.
3. Find out if there are less costly options you can try: If you
learn you are taking an expensive drug or one that’s not covered by your drug
plan, call your doctor to find out if there are generics or older, less
expensive drugs that you could try. When trying out a new prescription ask your
doctor for free samples, to allow time to determine whether it will treat your
condition as effectively, and to monitor for potential negative side
4. Find out if your drug plan offers mail order: If your drug
plan offers mail order you can often significantly cut your costs by using it.
Generally, mail order requires a 90- day prescription, but often your cost is
the same as what you would pay for a 60-day supply from a retail pharmacy.
5. Split your pills if you can: You can further cut your costs in
half by splitting your pills in half. Ask your doctor if pill splitting would
work with your prescriptions (not all pills can be split). Your doctor would
need to write a prescription with a dosage twice as high as you normally take.
You can readily find inexpensive pill splitters at your pharmacy. If you do
split your pills, make sure your family and emergency caregivers also know!
Carefully label all prescriptions that require splitting.
6. Compare generic costs: You sometimes pay more for common
generics using your drug plan, than you would simply by visiting a pharmacy with
$4 generic program. Compare the costs first. If the $4 generic saves you money
over your normal co-pay, put your drug plan card away and shop at the discount
pharmacy. Save your coverage for more expensive prescriptions.