5 Simple Strategies to Avoid the Part D Donut Hole

With the increasing cost of medications today, any senior who is on multiple medications becomes quickly aware of how vital Medicare Part D can be. Whether you are getting drug coverage through a Part D stand-alone plan or getting the coverage through a Medicare Advantage plan, getting help with your with the rising costs of medications is critically important.

Regretfully, the Part D coverage has a built-in coverage gap (donut hole) which, when the threshold is met, there is a temporary limit on what your Part D coverage will pay toward your prescriptions.

Certainly, the best way to make certain you don’t reach the donut hole threshold is by keeping your prescription drug costs as low as possible. But if or when you ultimately reach the “donut hole,” there are some strategies you can implement to help pay for medications you still need when they aren’t covered at the time you need them. Here are some recommendations that will help:

1. Purchase Generic Drugs

There are a lot of brand-name drugs that have generic alternatives which are typically not as expensive as the brand name drug. The Food and Drug Administration has set specific rules about generic alternatives that makes sure the patient will get the same ingredients and dosage as the brand name drug. Always ask your healthcare provider to determine if any medications you are taking have a generic alternative and if so, change your prescription as soon as practical.

2. Order by Mail

A lot of medications covered by Part D can be purchased at a discount if you agree to purchase a 90-day supply by mail instead of picking them up at the pharmacy each month. Nowadays, many local pharmacies are offering a discount if you purchase a 90-day supply in the store rather than using a mail-order facility. Certainly, not every medication can be purchased in 90-day quantities but whenever possible, it makes sense to get the 90-day supply discount to help reduce your overall cost of medications.

3. Apply for Discounts

Lately, since more and more pharmaceutical companies are advertising directly to the public, you have noticed at the end of the commercial that you can contact the company for help with your prescription cost. Although these offers are primarily for brand-name drugs, it makes a lot of sense to contact the company (online is the easiest way) to see if they have a program that reduces the cost of the drug, even if only on a temporary basis.

Sam Wilson was prescribed Anoro by his pulmonologist as a treatment for severe COPD. When Sam spoke with the pharmacist, he was told that his insurance company did not cover the drug and a 30-day supply would cost $453. Sam visited the manufacturer’s website and found that the company has a year-long program where if qualified, Sam could get the drug for $10 per monthly supply. Sam filled out the application, it was immediately approved, and Sam was able to print a coupon that he would take to the pharmacist.

4. Check out Part D Drug Plan Assistance Programs

The Extra Help program administered by Medicare can be very helpful if you qualify. The program is intended for individuals and married couples who are living on a very low income so you will have to complete an application to find out if you qualify. According to Medicare.gov, some people will qualify automatically for Extra Help if they meet certain conditions.

If you don’t qualify for the Extra Help program from Medicare, many states have programs that can help with your cost of medications. You can check with your state’s Medicaid program or your state’s State Health Insurance Assistance Program for more information.

5. Get a Different Part D Plan

Some Part D Plans have begun offering prescription drug benefits when you are in the donut hole. The downside to these plans is they are more restrictive on the drugs they will cover and their premiums are generally higher than Part D plans that do not offer donut hole coverage. Even though you may end up paying more for a plan that does cover you in the donut hole, it may work out better for you financially so it’s certainly worth looking into.

The best way to deal with the Part D coverage gap (donut hole) is not to meet the threshold. You can reduce your prescription drug costs by planning ahead and by using the five strategies listed above, and in many cases, those who would have likely entered the coverage gap can prevent it altogether.