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I saw your Facebook post regarding a foundation that is supposedly going to provide several diabetes medications for free. Can you confirm and explain the program and details?
It’s true and one of the most important and exciting pieces of news since PACENET raised their income limits almost two years ago.
One of the largest biotech and pharmaceutical companies in the world has announced some changes to their Patient Assistance Program that will immediately provide those on Medicare several commonly prescribed and very expensive diabetic medications for free. It’s their way of “giving back” during the COVID pandemic.
Prior to this announcement, in order to qualify for free medications, a couple of milestones had to be met first; One’s Doughnut Hole, which we will explain momentarily, had to be reached and $1,000 also spent on drugs.
That is no longer the case, which is a fantastic development. Here’s the bottom line. Any household with a gross annual income under 400% of the Federal Poverty Level qualifies! Those limits are as follows: $51,040 for a single person and $68,960 for a married couple. Keep in mind assets and other holdings such as savings, checking, stocks, bonds, 401ks, etc., don’t have any impact on qualifying, which is also good news. Those who are accepted can have their medications shipped out in as little as two weeks according to the program guidelines. Here is the list of eligible diabetes medications: Insulins; Levemir, Tresiba, and Novolog. Non-insulin injectable Type 2 medications; Ozempic and Victoza. There are also a few other less commonly prescribed drugs on the list as well.
Again, these medications are extremely expensive. The lowest, Levemir, retails for just under $500 for a 30-day supply and the highest, Victoza, just under $1,000. Listen to my next podcast as we discuss a few of the reasons why these medications are so expensive, as much as 300% more than in other industrialized countries all over the world. Which brings us to the Doughnut Hole, which did not go away as had been promised. Those on Medicare can only receive $4,020 worth of retail medications. What you pay for them, i.e. copays or deductibles has nothing to do with that figure. Only the actual cost does. For example, because the retail for Victoza is almost $1,000, those who take it would exhaust their $4,020 in only four months and then enter the Doughnut Hole. Once that happens, co-pays increase from an average of $35 to $45 for a 30-day supply to 25% of the retail. In the case of Victoza, that would come to almost $250!
You can see how valuable, between $1,000 and $2,500 in savings on average, this program will be for those who take these ridiculously expensive medications. I certainly hope other pharmaceutical companies will imitate this program, especially considering they’re some of the most profitable corporations in the world. The top ten biotech and pharmaceutical companies made a combined net profit of $77.36 billon in 2019 alone according to the German database company, Statista. In case you’re curious, Johnson and Johnson was number one at over $16 billion.
Please keep in mind we were told those who qualify and get these diabetes meds for free in 2020 will have to reapply in 2021. I’m predicting once again those on Medicare will not be eligible until they meet the prior qualifications, hitting the Doughnut Hole and spending $1,000 out of pocket on medications, before qualifying to get them for free. I will be keeping tabs on this development and letting the public know either way. My advice is to have a plan if my prediction comes true. There are several options. Ask your doctor if your A1C has dropped significantly since starting them and if it’s possible to come off your expensive diabetes medications, especially these new non-insulin injections. Could diet and exercise be an alternative? Do you qualify for PACENET, which would eliminate the need to even apply for Patient Assistance Programs. The qualifications for PACENET are as follows. Single = $29,120, Married = $38,740.
If none of the above are possible, at least ensure you have the most cost-effective Medicare Part D or Advantage Plan every year. We evaluate that each Annual Election Period for all our clients. We can do that for you as well if you like, even if you aren’t a current client. Simply call or email us and ask to be put in our database and we will mail you the same annual recommendation letter we do our clients every Fall.
If you have questions regarding the program or would like a copy of the application, again, call one of our offices or email me directly (aaron@ getyourbestplan.com). We will be happy to talk you through the process. And as always, we never charge for these or any other services, including consultations for those going on Medicare for the first time or anyone who would like to have their current plan analyzed and compared to others on the market.
Don’t forget to go to our website where you can listen to my latest podcasts. You can subscribe to them for free by clicking on the “podcast gallery” tab on the top right of the page and the “follow” tab. You will then get email updates whenever a new one is recorded.
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