Medicare Part D - Prescription Coverage - Assistance

Pam Flores @phflores Health Guide
  • Are you on Medicare and having trouble filling your prescription meds? If so, help is on the way or maybe you've already received it.

     

    Checks in the amount of two hundred and fifty dollars have been sent to all those on Medicare Part D who are currently in the donut hole a.k.a. the coverage gap. There's nothing you need to do to get this other than be in the coverage gap on Part D. No forms to fill out or anyone to contact. For those in this area of coverage, or I should say non coverage, you'll automatically get a check mailed to your address through Medicare.

     

    Some of you may be lucky and not have any prescriptions that come in brand name only. But there must be a large number of members that can't get Evista, Forteo, Actonel or Boniva, since all of these meds are only available in brand name, and there is no generic equivalent for any of the above.

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    Fosamax, some HRT's (hormone replacement therapies) and calcitonin come in generic but that's about it. Generics don't become available until the original patent on a drug expires which allows other companies to make a generic version.

     

    If you've been having trouble getting your osteoporosis meds filled due to this Part D rule, hopefully the two hundred and fifty dollar check - given to those in the coverage gap - will help to get some prescriptions filled.

     

    For a short break down of Part D's coverage gap, here's how it works. You and your insurance company need to have spent $2,830.00 on your prescription drugs, so far for the year to reach this gap in coverage. To explain further, when you get a prescription filled you pay your co pay and the insurance pays the balance of the total priced charged. Each time you get a prescription filled, you'd add these two figures and when you reach a total of $2,830.00 spent by both you and your insurance, you no longer have brand and in some cases even generic coverage until the next calendar year. Check with your individual plan to see what type of coverage you have since they all are different and your individual coverage may vary. However, if you have high cost prescription meds, your coverage kicks back in when you and your insurance company have spent $4,550.00. Once you reach this amount spent, you have a small co pay for the remainder of the year.

     

    I hope that most of you don't have to deal with the gap in coverage, and for those who have reached it, I sure hope you've received your check in the mail to help ease the enormous cost of these drugs.

     

    Sources:

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    Medicare and You 2010, Centers for Medicare and Medicaid Services pages: 65-66

Published On: August 31, 2010