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keeperumiami
keeperumiami, Senior Tax Expert & Financial Planner
Category: Social Security
Satisfied Customers: 6179
Experience:  Sr Tax Expert/Financial PlannerCPA/PFS (retired)Over forty years of advising individuals & small businesses
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Ife and I are living on SS Benefits. The outrageous prices

Customer Question

ife and I are living on SS Benefits. The outrageous prices we are paying for our medications eats up over half of our checks. We have pharmacy coverage, but the doughnut hole makes it almost useless, Is there any help available?
JA: These retirement benefits are supposed to help us but they can be so complicated! The Retirement Expert will help you get the most benefits propertly. Is there anything else important you think the Retirement Accountant should know?
Customer: OK. How do I get in touch with him/her?
Submitted: 1 month ago.
Category: Social Security
Expert:  keeperumiami replied 1 month ago.

Hello, my name is***** goal is to give you a complete & accurate answer. I am working on your request now & I will respond as soon as possible.

Expert:  keeperumiami replied 1 month ago.

I understand your dilemma, as I have experienced the same problem with the so-called "donut hole".

Believe it or not, there is some additional help available, but it takes some work to ferret it out and it depends upon which medications you are taking and what the nature of your coverage is.

This is the ideal time of the year to re-evaluate your prescription plans available as well as to determine what additional assistance may be available from other sources.

Here's what I would do:

1. Depending upon what state you reside in, your state Public Assistance Department may provide supplemental assistance with both the cost (Premium) of your Prescription Insurance Plan as well as coverage of prescription costs depending upon your income level. If you don't know how to reach the correct department in your state, your local Senior Citizen Center should have the name of the agency that would assist you to determine what may be available that you may qualify for. The will also be able to assist you with determining what the best insurance plan is for you based upon the actual prescriptions you are actually taking. In fact, you can do that yourself online at "Medicare.gov". You can actually enter your specific prescriptions and they will run them through their program and tell you which plan is best based upon what's available and the reimbursement/coverages for your specific prescriptions.

2. Many Chain Drug Stores (such as CVS, Stop & Shop, Walgreen's, Walmart) have made special arrangements with certain of the Drug Manufactures to give special pricing to their customers who either don't have prescription insurance coverage or have limited coverage, or whom are in the so-called "donut hole". The problem is that those of us on Medicare aren't automatically eligible for this pricing. I can give you an example that has assisted me in a big way, and I do so only so that you don't think this is some "pie in the sky" wild goose chase. One of my prescriptions is a Tier IV prescription for which there is no generic and no alternative that my doctor will prescribe. I have pretty much the best Blue Cross Prescription Coverage. Before I hit the "donut hole", my monthly co-pay for this drug is $70., once I'm in the "donut hole" I was paying $180. a month for the drug. My pharmacy is Stop & Shop. The druggists there are exceeding helpful and discovered, pretty much by accident, that Stop & Shop has some arrangement with the manufacturer of the drug so that under Stop & Shop's own free Prescription Discount Plan, (not an insurance plan) the drug costs $25. a month. They put the prescription through their own plan, bypassing my Medicare Part D plan. So, instead of paying $180. a month all this year, I've been paying $25. The drug is not available by mail order, so I couldn't save that way for this particular drug. All of these chains have their own discount plans so it is definitely worth asking about a similar plan where you shop in terms of your particular prescriptions.

3. Finally, just about all of the Drug Manufacturers have plans to provide their medications directly to your physician or to you if you are low income and thereby qualify for their discounts. You simply need to go to the Manufacturer's websites for the prescriptions that you take and fill out applications to see if you qualify. One point I'll make as it confuses a lot of people. Once you are in the "donut hole" often, particularly with brand name drugs" you are not receiving actual prescription insurance coverage, but are paying a discounted amount that your prescription plan has negotiated, with limits according to the Affordable Care Act as it affects the "donut hole". So, under those circumstances, when you fill out a Manufacturer's Application for their discount or free medication, for that particular drug, you can "check the box" where you indicate you have NO INSURANCE COVERAGE for that drug. Often, that is enough to qualify for their program.

Those are my best 3 recommendations of things to investigate, where I have either personally benefited from them or I know of specific instances where someone has recently benefited from them. They are definitely worth the time & effort to investigate them. I'm sure there are others, such as dealing with your plan's mail order prescription options where you may be able to obtain 2 or 3 months' supply for the same co-pay as you pay for 1 month at your local pharmacy.

Good Luck & I sincerely ***** ***** can locate some assistance for your circumstances/situation.

Steve G.

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