While a majority of us who are on Medicare have enrolled in the Medicare Part D program, many of us do not have private insurance and do not qualify Medicaid coverage to help with the high costs of prescription drugs. For those of us who have only Medicare Part D coverage, we find ourselves in the coverage gap, or donut hole, well before the end of the year, having to pay full price for prescriptions. While some medications have come down in price because of generic substitutes, others have not and generics may not be available for several years in the future.
Many major pharmaceutical companies offered free or low-cost prescription drugs to patients who had no insurance or were under-insured prior to the enactment of Medicare Part D. Once Medicare Part D became law, many of those pharmaceutical companies continued to offer patient assistance programs to those who had no insurance coverage.
Over the past four years, some drug manufacturers have revised their eligibility requirements, allowing Medicare Part D patients to obtain much-needed prescriptions once they fall into the coverage gap. Patients must fill out an application that includes household income, a statement of out-of-pocket expenses for prescriptions paid by the patient, and a signed statement from their physician. A new scrip from their doctor must accompany the application. All applications are reviewed on a case-by-case basis, and patients will be informed by mail whether or not they have been approved. If the patient is approved, prescriptions are filled for a ninety-day supply and shipped to either the patient or the doctor’s office.
You can go to rxassist.com/org to look up the name of the pharmaceutical company that manufactures your medication. When you submit your entry, you will be brought to a site that lists all medications for which that company offers patient assistance programs. By clicking on your specific medication, you are directed to a page that lists eligibility requirements and a place where you can download and print an application.
Some of the main pharmaceutical companies that offer patient assistance programs to Medicare Part D patients are as follows:
Abbott Labs – will make exceptions for Medicare Part D patients on Humira dependent upon household income and health expenses.
AstraZeneca – accepts Medicare Part D patients who have spent 3% of the annual income on prescription drugs.
Boehringer Ingleheim – makers of Spiriva, accepts Medicare Part D patients who do not have private insurance and have spent 3% of their annual income on prescription drugs.
Merck – may provide assistance after a Medicare Part D patient has been denied and files an appeal.
Pfizer – the makers of Lipitor, Norvasc and Zithromax will provide assistance if the patient is experiencing financial and/or medical hardships. The patient must call a toll free number to apply.
Sanofi-Aventis – those with medical hardships can apply. Applications are reviewed on a case-by-case basis.
Wyeth Labs – Medicare patients can submit an application along with a letter explaining the financial/medical hardship.
I welcome many of the new facets of the health care law that was enacted this year. However, it still does not help those of us who fall into the coverage gap. I hope that the pharmaceutical companies will continue to offer patient assistance programs until the coverage gap is ultimately eliminated. I hope you check out the rxassist.org site for yourself, a family member, friend or neighbor who may be struggling to pay for their medications.