The Price of Enbrel and Medicare Part D
On a limited budget a lot of seniors on a tight income have very little dollars to pay for their medicine. However, for those seniors who have a chronic condition, the Medicare Part D coverage gap can be a real shock. At the beginning of the second quarter of the year there is much talk regarding the donut hole or coverage gap. How does it work, what is it, and why is it there? How does it provide prescription drug help?
To decrease the cost of Medicare’s Part D coverage, the coverage gap was created. The yearly limit for Part D is set each year. The annual limit in 2007 was $2400. The annual limit was increased in 2008 to $2510. The amount is $2700 in 2009. The amount is calculated on the total costs of the prescription medicine that you receive. This includes your co-pays and what the insurance company pays. For example, if a medication costs $550 and the insurance company pays $500 and the recipient pays $50, the amount that goes towards the yearly limit is the entire $550
When you are in the donut hole, you are responsible for the cost all of your prescription medication. There are a lot of Medicare part D plans that offer coverage for generics when you are in the coverage gap. The cost of most generic drugs is so low that the benefit of having them covered by a Part D plan is not that great of a benefit. It could be worth it to have prescription coverage for generics for some patients because everyone’s situation varies.
The donut hole can be reached in a matter of months by Medicare Part D people with chronic health problems which often require high priced drugs for treatment. We have witnessed people reach the donut hole or coverage gap as soon as February. Encouraging patients to purchase cheaper prescriptions when possible is the reason for the donut hole. This punishes those patients who must use high priced drugs because nothing else works.
Patients with rheumatoid arthritis can fall into the coverage gap within 2 or 3 months due to the price of Enbrel. The option at this point is to pay for the medication at full price for several months until the catastrophic coverage portion applies or suffer the potentially disabling consequences of coming off their prescription medication. Roughly $50 a day is what Enbrel costs. There are many senior citizens who are not able to pay for that.
Some people will be able to sign up for patient assistance programs because of their income levels.
Going directly to the manufacturer can be very helpful in getting low or no cost prescriptions. Contact the company and ask about their Prescription Assistance Program. Most all drug companies offer such programs, which enable consumers to receive medicine they need at a price they can afford (often for free). A lengthy application co-signed by your physician is typically necessary for entry into the program. Patient Assistance Programs run by manufacturers have been in existence for over 20 years. These programs are designed to assist eligible patients who cannot afford their prescription drugs due to low income or other financial hardships. Drug manufacturers did not want their low income patients to be forced to make a choice between paying for life saving prescription medicine 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 people knew about these programs or could follow the complicated application process that was required for participation. Often times multiple applications had to be filed. Please do your research and get the help with prescriptions that you need.
