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I went into my Doughnut Hole in August this year and my co-pays went way up. Can I
avoid that next year by moving to another Part D or Advantage Plan for 2021?
No. Unfortunately, you can’t. There isn’t a Part D or Advantage Plan on the market that doesn’t have higher costs for brand name medications in the Doughnut Hole, also referred to as the Coverage Gap.
This is another sour topic for me because seniors were told when the Affordable Care Act was being negotiated and passed that the Doughnut Hole would eventually be closed, which in definition meant the costs would be just 25% of the retail price. And in 2010, that sounded great because brand name drugs had an average retail cost of $125 for a 30-day supply. At that time, when people found themselves in the Doughnut Hole, they had to pay full retail for medications. At 25%, the co- pay would only be around $30 on average. The drug manufactures were going to be giving Medicare beneficiaries a 75% discount. That was how it was sold to the public. Well, something happened between now and then. Drugs prices increased dramatically as manufactures started to give these so-called discounts. And here we are, just 10 years later, the average cost of a brand name medication at $500 for a 30-day supply. The reality is people are not seeing any discount in the Doughnut Hole because they’re still paying $125 on average for a 30-day supply of brand name drugs.
To make matters worse, because the cost of medications is so ridiculously inflated, millions more seniors are finding themselves in the Coverage Gap than 10 years ago. It’s been extremely frustrating watching this fraud play out and Big Pharma get richer on the backs of taxpayers, seniors, and employers while politicians on both sides of the aisle looked in the other direction.
Our whole prescription drug industry needs reformed. When the same exact brand name medications, manufactured in the same exact facilities, can be purchased in Canada for as little as 15% of the US cost, politicians and Big Pharma have some explaining to do. Spare us the Research and Development argument because common medications such as Advair and Novolog insulin pens, introduced in 2001 and 2003 respectively, were brand name until very recently and saw almost
a 400% increase in cost since 2010. The media won’t cover the topic because they can’t afford to alienate their biggest advertisers, pharmaceutical manufactures. Here’s just one example, Breo, one of the least expensive brand name drugs and a very common medication to treat COPD, emphysema, and chronic bronchitis, retails for $350 for a month’s supply here in the US. It can be purchased in its brand name form from an accredited Canadian Pharmacy for just $45 without using insurance.
This is one way that many people can avoid reaching the Doughnut Hole, getting medications out of Canada. In addition to being able to purchase the same brand name medications across our northern border at a discount, many medications that aren’t yet generic in the US are in the rest of the world and available for a fraction of the cost of the brand name version. And they’re manufactured in the same countries and facilities as other generic drugs US citizens are currently taking, another well kept secret Big Pharma doesn’t want you to know.
The pharmacy industry and Part D can be so confusing, but there are ways to beat the system. Here’s an example. Restasis single use vials retail for over $500 for a 30-day supply. A multi-use vial that lasts many people 30 days, retails for just $55 right here in the US. The savings from using the latter would be a minimum of $700 per year, possibly much more depending on what other medications one was using.
PACENET is the easiest way to save money on medications and guarantees no more than a $15 co- pay for any brand name drug. It also eliminates higher costs in the Doughnut Hole. The income limits to qualify are as follows: $29,235 for a single individual and $38,970 for a married couple. Assets aren’t used to determine eligibility so money in savings, retirement accounts, or other investments won’t keep anyone from being accepted.
For those who don’t qualify for PACENET, Patient Assistance Programs (PAP) are available for almost every medication on the market. Those who qualify get their expensive medications for free. Most programs have income limits of 300% to 400% of the poverty level, which means single individuals who make $38,000 to $51,000, and married couples who earn $52,000 to $70,000 annually, will qualify depending on the program. Each drug manufacture has slightly different income limits and benchmarks.
I know all this information and data may seem overwhelming to many readers, so let me make a suggestion. Become a client of The Health Insurance Store and we’ll ensure you’re aware of all the ways you can save money on prescription drugs. We’re constantly researching options, various programs, and foundations. We pass these findings on to our clients and help them apply for PAP’s, PACENET, and make suggestions such as the Restasis example. Our goal is to sit down with every client who’s in danger of reaching their Doughnut Hole and come up with an individual game plan. Our full attention is dedicated to health insurance related products only, and our agents and staff have over 30 years of combined experience. We don’t just work during Annual Election Period either. We’re available 40 hours a week, year-round, when something unexpected occurs such as high medical or prescriptions costs, a denied claim, erroneous bill, etc. No one knows the ins and outs of the health care and insurance industries better than The Health Insurance Store. We’re 100% dedicated to taking care of and advocating for clients, with the goal of making Medicare stress free for those who choose our agency.
I’m very confident not only can we show you how to save money on prescriptions, but on Medicare Advantage Plan, Supplement, and Part D premiums, as well as out of pocket medical costs. Call one of our offices for a no cost consultation and feel free to contact me directly via email with any questions. Aaron@ GetYourBestPlan.com
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.