Rx Help With Enbrel and Medicare Part D

For a lot of senior citizens who live on a fixed income, Medicare Part D has been an answer to their prayer. For those patients who have a chronic condition, it can be a tough realization when they hit the Medicare Part D gap in coverage. At the beginning of the second quarter of the year there is much talk regarding the donut hole or coverage gap. Why is it there, what is it, and how does it work?

Medicare's Part D cost was decreased by creating the coverage gap. The yearly limit for Part D is determined each year. $2400 was the 2007 yearly amount. The annual limit was increased in 2008 to $2510. The amount is $2700 in 2009. The total costs of the prescription medicine that you receive is how the limit is determined. This includes your co-pays and what the insurance company pays. For example, if a drug is priced at $550 and the insurance company pays $500 and the patient pays $50, the amount that goes towards the annual limit is the full $550 the yearly amount is the full $550.
During the time you are in the coverage gap, you are responsible for the cost all of your prescription drugs. While in the donut hole or coverage gap, several Medicare Part D plans will provide some type of coverage for generic drugs. The cost of most generic drugs is so low that the benefit of having them covered by a Medicare Part D plan is not that much of a benefit. For many people it might be worth it to have coverage for generics, everyone's situation varies.

The donut hole or coverage gap can be reached in a matter of weeks by Medicare patients with chronic health problems which often require expensive medications for treatment. We have witnessed people reach the donut hole or coverage gap as early as February. Steering people to use cheaper prescription medicine when possible is the whole point for the donut hole. Because nothing else works it punishes those patients who must use high priced prescription medicine. Patients whose rheumatoid arthritis is successfully controlled by Enbrel can go into the coverage gap within 2 or 3 months because of the price. Then, they must pay for their prescription medications at full price for the remaining months until the catastrophic coverage portion of Part D kicks in, or suffer the potentially disabling consequences of coming off their medications. The price of Enbrel is roughly $18,000 annually. There are very few senior citizens who are able to afford that.

Qualifying for patient assistance programs will assist some lower income people. The best way to get low cost or free medicine is to talk to the drug manufacturer. Contact the company and ask about their Prescription Assistance Program. Most all drug manufacturers offer such programs, which enable consumers to receive medicine they need at a price they can afford. A lengthy application co-signed by your doctor is typically necessary for entry into the program. Patient Assistance Programs run by drug manufacturers have been in existence for over 19 years. These programs are designed to help eligible individuals who can't afford their prescription drugs due to low income or other financial hardships.

Manufacturers did not want their low income customers to be forced to make a choice between paying for life saving prescription drugs or for paying for rent or groceries. As a result, patient assistance programs came into being as part of the company's philanthropic efforts. Until relatively recently, very few patients knew about the existence of these programs or could follow the complicated application process that was necessary for participation. Often times multiple applications had to be filed with several different pharmaceutical companies in order to gain access to assistance programs.
The manufacturers seem to believe that providing information on their websites and toll-free numbers is all that patients need to access PAPs. They don't grasp the inability of many people, particularly those on multiple drugs from 2 or more doctors to follow through with the fragmented application process. It also places an unfair burden on the physicians that are already overwhelmed with paperwork. Fortunately there are companies that will perform the task for patients for a fee. These prescription assistance companies will generally coordinate the process from beginning to end. Of course the prescription assistance is free and if patients will do it themselves they should, but for those people that just don't have the ability to do it themselves, the hiring of a professional to do the job is a better option than not taking the prescription medicine they need.

Do you need prescription drug help ? Kirby Horton has been helping Americans with their healthcare needs for close to 30 years. He is the Founder of Rx Help, a Prescription Assistance Company. He can be reached at 866-960-9497 and you can follow his blog at Rx HELP Blog.