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The Cost Of Enbrel And Medicare Part D

Published by Kirby Horton | June 4th 2009 | Views:

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For most senior citizens who live on a fixed income, Medicare Part D has been an answer to their prayer. For those senior citizens who have a chronic illness, it can be a tough realization when they hit the Medicare Part D gap in coverage. By the end of the second quarter of the year you hear a lot of talk about the donut hole or coverage gap. How does it work, what is it, and why is it there?

To decrease the cost of Medicare’s Part D coverage, the coverage gap was created. The yearly limit for Part D is determined each year. In 2007, the yearly amount was $2400. The yearly amount was increased in 2008 to $2510. $2700 is the limit in 2009. The limit is calculated on the total costs of the drugs that you receive. What the insurance company pays and your co-pays are included in this calculation. For example, if a prescription is $750 and the insurance company pays $700 and the patient pays $50, the amount that goes towards the yearly limit is the enire $750.

When you are in the donut hole, you are responsible for the cost all of your prescription drugs. There is coverage for your generic drugs when you are in the donut hole. The cost of most generic drugs is so small that the benefit of having them covered by a plan is not that great of a benefit. For some people it might be worth it to have prescription coverage for generics, everyone’s situation varies.

In just a few short months a Part D person with chronic health problemtis and the price of it can cause the patient to reach the donut hole or coverage gap within 2 or 3 months. Then, they must pay for their prescriptions at full cost for the remaining months until the catastrophic coverage portion of Part D kicks in, or suffer the potentially disabling consequences of stopping their medications. The high cost of Enbrel is approximately $1,500 per month. There are very few senior citizens who can afford that.

Qualifying for patient assistance programs will help some low income patients. One of the best ways to get low cost or free prescription medicine is to talk to the manufacturer. Contact the company and ask about their Prescription Assistance Program. Almost all pharmaceutical companies offer these programs, which enable patients to receive medicine they need at a price they can afford. You and your healthcare provider will need to complete an application. Patient Assistance Programs run by drug manufacturers have been in existence for over 17 years. These programs are designed to assist eligible individuals who cannot afford their drugs due to limited income or other financial hardships.

Drug companies did not want their low income customers to be forced to make a choice between paying for life saving prescription drugs or for paying for rent or groceries. As a result, patient assistance programs came into being as part of the company's philanthropic efforts. Until relatively recently, very few people knew about these programs or could follow the complicated application process that was required for participation. In many cases several applications had to be filed with several different pharmaceutical companies in order to gain access to prescription assistance programs.

The drug manufacturers seem to believe that offering information on their websites and toll-free numbers is essentially all that patients need to access PAPs. They just don’t understand the inability of many patients, particularly those on several drugs from 2 or more doctors to follow through with the difficult application process. It also places an unfair burden on the healthcare providers that are already swamped with paperwork. Fortunately there are companies that will perform the task for people for a fee. These prescription assistance companies will generally coordinate the process from beginning to end. Of course the prescription assistance is free and if patients are capable of doing it themselves they should, but for those patients that just do not have the ability to do it themselves, the hiring of a professional to do the job is a better option than not taking the prescriptions they need.


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