We designed our
online PDP-Planner or Doughnut Hole Calculator to help give Medicare Part D beneficiaries an idea when they will go into the Doughnut Hole or coverage gap.
However, many people are already in the Doughnut Hole and looking for some form of relief from their high prescription drug costs. And if these Medicare beneficiaries have monthly retail prescription costs under $514, they probably will stay in the Doughnut Hole until the end of 2009 (this estimate is based on a standard or basic Medicare Part D plan with 25% co-insurance - and this retail value will increase each year - the updated values for 2010 can be found here:
https://q1medicare.com/2010/).
The Centers for Medicare and Medicaid Services (CMS) provides some helpful ideas for people in the Doughnut Hole:
1. Consider Switching to Generics, Over-The-Counter (OTC), or Other Lower-Cost Drugs
Ask your doctor about generic, OTC, or less-expensive brand-name drugs that would work just as well as the ones you’re taking now. Switching to lower-cost drugs may be enough to help you avoid the coverage gap, and can save you hundreds of thousands of dollars a year.Cost savings information through the use of mail-order pharmacies, generic, or less-expensive brand-name drugs is also available by visiting the Compare Medicare Prescription Drug Plans section of www.medicare.gov.
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Online Editorial Team Note - See also http://www.fda.gov/cder/consumerinfo/generics_q&a.htm ]
2. Keep using your Medicare drug plan card, even while in the coverage gap.
Using your drug plan card ensures that you’ll get the drug plan’s discounted rates and that the money you spend counts toward your catastrophic coverage.
3. Explore National and Community-Based Charitable Programs
Explore National and Community-based charitable programs that might offer assistance (such as the National Patient Advocate Foundation or the National Organization for Rare Disorders). These organizations may have programs that can help with your drug costs. Comprehensive information on Federal, state, and private assistance programs in your area is available on the BenefitsCheck Up (www.benefitscheckup.org) website.
[Online Editorial Team Note #2 - Florida residents may note that Publix will no longer meet Walmart's $4 generic drug price, however, Publix will offer antibiotics. As noted in their Press Release entitled:
Publix Pharmacies Launch Free Prescription Drug Program in All Operating Areas
"Beginning today, Publix Super Markets chain-wide is offering a free prescription drug program at its 684 Publix Pharmacies for the following oral antibiotics
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Amoxicillin
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Cephalexin
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Sulfamethoxazole/Trimethoprim (SMZ-TMP)
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Ciprofloxacin (excluding ciprofloxacin XR)
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Penicillin VK
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Ampicillin and
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Erythromycin (excluding Ery-Tab)."
(Publix Press Release http://www.publix.com/about/newsroom/NewsReleaseItem.do?newsReleaseItemPK=2636 08/06/2007)]
4. Look into Pharmaceutical Assistance Programs
Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs or PAPs) may be offered by the manufacturers of the drugs you take. Many of the major drug manufacturers are offering assistance programs for people enrolled in a Medicare drug plan. You can find out whether a Pharmaceutical Assistance Programs offered by the manufacturers of the drugs you take by visiting www.medicare.gov and selecting “Lower Your Costs During the Coverage Gap” - or by visiting the Medicare Pharmaceutical Assistance Program site at https://www.medicare.gov/pap/index.asp.
5. Look at State Pharmaceutical Assistance Programs
Check with your state to see if there is a State Pharmaceutical Assistance Programs (SPAPs) for which you may qualify. As of 2009, there were 23 states and 1 territory offering some type of coverage to help people with Medicare with paying drug plan premiums and/or cost sharing. You can find out if your state has a State Pharmaceutical Assistance Program by visiting www.medicare.gov and selecting “Lower Your Costs During the Coverage Gap.”
You can also find out if your State has a program by visiting the State Pharmaceutical Assistance Program site at https://www.medicare.gov/spap.asp.
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Online Editorial Team Note #3 - Look to see what is available in your local community or county. For instance, Seniors in Anne Arundel County (Baltimore, Maryland) can get savings on prescription medications through the Department of Health's Prescription Discount Program. As noted in the Baltimore Sun: "Program participants can receive a discount card that offers an average discount of 25 percent. County residents enrolled in Medicare Part D can use the card for savings on prescriptions that are not covered by their Medicare Part D program." (Baltimore Sun, Senior Notes, 08/15/2007) To get more information, Seniors can call: 410-222-4464 (or the Senior Health Insurance Program).]
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Online Editorial Team Note #4 - Check out the website NeedyMeds.com for more information on State Pharmaceutical Assistance Program (SPAPs). and also a nice overview from the Medicare Rights Center site: http://www.medicarerights.org/rxchart_states.html]
6. Apply for Extra Help
If you have Medicare and have limited income and resources, you may qualify for extra help paying for your prescription drugs. Contact Social Security by visiting www.socialsecurity.gov or by calling 1-800-772-1213. TTY users should call 1-800-325-0778
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Online Editorial Team Note #5 If you qualify, you could pay between $1.10 to $6 for each drug (these values increase every year and you can find the most recent figures in our Part D plan outlook:
https://q1medicare.com/2010/).]
(Source: CMS Publication No. 11213
Revised August 2009 - with Q1Medicare.com additions)