UNITED STATES—Toni: Last year, my mother got into the “donut hole” in October. I can see from the Part D statement she receives that she has hit the donut hole in June of this year. Her prescription drugs have not changed from last year.
She can afford her co-pays of $180 per month that she pays at the pharmacy. The monthly Part D statement says the prescription drugs retail cost is $802 per month. I am confused.
Please give me ideas to help control the donut hole cost! Thanks, Jennifer from Dallas, TX.
Jennifer: Your mother’s prescription drug problem is a typical problem since the cost of brand name prescriptions has risen dramatically. She can afford her $180 co-pays, but has no idea that the actual cost of her prescription drugs is $802 each month.
Once the retail price of her prescription drugs total $4430 for 2022 for her covered drugs, then she is in the famous “Donut Hole” or coverage gap for her Medicare Part D plan.
She must pay $7050 retail price to get out of the “Donut hole.” She will pay 25 percent for a brand name drug, the brand name drug manufacturer will pay 70 percent of that covered brand name drug and the remaining 5 percent will be paid by the prescription drug plan which she enrolled in.
What happens if your brand name drug is not a “covered” brand name drug on your specific Part D plan? You will have to pay 100 percent of that brand name drug cost.
Generics cost less, and for 2022, the cost is a 25 percent co-pay when in the “Donut hole.” Unfortunately, many brand name drugs do not have a generic alternative to use.
That is why it is important when choosing a Medicare Part D prescription drug plan, whether enrolling in Medicare for the first time or during Fall’s Medicare’s Annual Enrollment, to be sure all prescriptions are covered on your Medicare Part D plan.
Do research prior to enrolling in a Part D plan because if you choose the wrong plan, you cannot change it until Medicare’s Annual Enrollment Period, which is from October 15 to December 7 every year.
January 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and different costs, deductibles, and a new donut hole.
Toni Says® Tips to help you stay out of the Donut Hole or not get in it as soon!
1) Visit www.medicare.gov when selecting a Medicare Part D plan, whether it is your first time or changing during Medicare’s Annual Enrollment Period in the fall. This is an accurate way to view the cost of drugs, which Part D Prescription Drug plan meets your needs, and pharmacy that is most cost effective.
2) Talk to your Primary Care and specialty doctors about which brand name drugs can be changed to generics.
3) Get samples from your doctor.
4) Search various Prescription drug programs such as GoodRx or Single Care for inexpensive prescription drug cost. HEB, Wal-Mart, Kroger and Costco also have discount prescription drug plans. To get their discounted price, you only need a prescription from your doctor.
5) Contact the Texas A&M Medication Assistance Program at 866/524-1408 for extra help. This organization has saved over $64 million dollars helping people receiver expensive brand-name prescriptions at affordable prices when they cannot afford the Part D cost for them.
6) Sign up for Toni Says® newsletter at www.tonisays.com to keep up to date on Medicare changes. For answers to Medicare questions, email firstname.lastname@example.org or call 832-519-8664.
Toni King, author of the 2022 Medicare Survival Guide® Advanced edition is giving a $5 discount on the Medicare Survival Guide® Advanced book at www.tonisays.com.