I cannot believe we are eight months into the year already! WOW! For me that means I am right around the time my worst dessert is being served - the darn donut hole!
What is a donut hole? The donut hole is the healthcare term used to describe a period when people with health insurance must begin to spend their own monies to cover the cost of medications up to the tune of approximately $4,100.00 out-of-pocket expenses!
Let's slow down for a minute. First, you have prescription coverage that reduces the amount of your out-of-pocket expenses for medication. This is known as your Co-pay.
Ok, now visualize a donut with all the colorful sprinkles and icing in your favorite color/flavor. That represents all the dollars your insurance company is willing to pay for your prescriptions and ususally at 80 percent of the drug company's charge. So you visit the pharmacy every month for your meds and you are chipping away at that donut (Lord, don't catch a cold, too).
Ok, eventually you have eaten all around that donut and there's NOTHING left but the hole!!!! Oh, no, that means....YOU start paying for your prescriptions at a cost of 100 percent with no health insurance paying anything towards your medications. This is especially fatal for individuals taking expensive maintenance medications (sugar diabetes, high blood pressure, depresion, etc.). This is especially harmful to individuals with a mental illness who typically have to suddenly interrupt medications or go without food, etc.
By now, we all have a 'donut hole' story and if not, stick around with your health issues a little while longer.
So, what can we do about the donut hole? There is hope and it will require some patience and diligence. One of the chief reasons I kept having Bipolar episodes during my early stages of treatment is that I could not afford the cost of medications. Because of that, I routinely skipped doses and I even stopped taking my prescriptions once for two months because I felt fine and could not afford them. One time I switched to an herbal drug (Johns Wart) and I believed I solved the problem of how to pay for my prescriptions.
Well, I can honestly tell you that I spent more time in and out of the hospital than when I resumed taking presciption drugs regularly. Other than the fact that I was tired of having an episode related to Bipolar, sick of being depressed, and scared to death when I read that the more episodes you have, the harder it is for the brain to recover when meds are started up again, I discovered that the mind is literally a terrible thing to lose...or play with!
But how was I going to afford the medications even at the co-pay cost with the drug prices going through the roof almost quarterly? Well, I did some research by asking questions and leaving no stone unturned. I swallowed all my pride and stopped depending on family members to give me money. I figured that I just could not be the only one too poor for meds.
What I learned was that every drug companies in the U.S. must provide assistance to consumers for their medication. Psycho-tropic drugs (all drugs for brain disorders such as depression, anxiety, etc.) can be either purchased directly from the pharmaceutical company at a discount or free if you qualify.
So, this is what happens. If you have a primary insurance drug plan, you have to spend X amount of dollars a year out-of pocket. Meanwhile, insurance companies will only pay a maximum amount for prescriptions then you are forced to pay for them entirely on your own. (I know there is something stupid about this considering you pay monthly premiums....healthcare reform will fix this!).
However, when you are in a donut hole, the pharmaceutical companies are there to help fill that hole. Halleluia! So, contact the U.S. drug company that makes your medication and ask to apply for assistance to get your meds. You will be asked income-related questions, etc. and then a decision is made informing you of what your out-of-pocket co-pay is. IN MOST CASES, you get the information for processing your prescription over the phone and by the time you drive to the pharmacy, stand in line, whola!, you fork over a few dollars and stay medicated, healthy, and mentally stable.
In other cases, you will receive a discount card within 10 business days or you can elect to have your prescriptions sent directly to your doctor.
For income eligibility, you will typically need your monthly or annual income amount, Social Security benefit statement, number of household members, drug name, and a receipt showing your out-of-pocket costs for the past 12 months. For example, if you take Seroquel, the name of the drug company that makes that medication is AstraZeneca.
The toll-free number is 1-800-957-6285.
Follow the choices for enrollment. You will need to have spent at least $450.00 out-of-pocket expenses for medications under the Medicare Part D plan. Your eligibility will depend on your household income, number of individuals. You can pre-qualify over the phone in which case you can purchase medication at a substantial discount/co-pay within about 30 minutes of providing all your medication. In some cases, there is no co-pay for you to pay. Now, in the case of Seroquel, you can purchase a 30-day supply for $15.00 or a 90-day supply for $30.00. You will continue to receive this discount until the end of the benefit year and then you are given a fresh donut for the next year. HALLEUIA-er!;)-
These documents will need to be mailed in to the drug company even though they grant you a temporary period of coverage. AstraZeneca is excellent for promptly processing your information and getting you your medication approval within 30 minutes. You can then get your prescription the same day!
If you are not eligible for free drugs, you are usually eligible for greatly-reduced drugs.
Remember one drug company cannot issue reduced costs for a drug that they do not make. For example, AstraZeneca can help with their drugs, but AstraZeneca cannot help reduce the cost for drugs made by Glenmark.
You will have to contact each drug company, but it is worth it. Consider if your total drugs by three different companies total $400.00 after you max out coverage, you could get those three drugs free or for under $100.00. Now, that's worth spending a few extra minutes on the phone contacting three different drug companies, right?!
Now, if you find yourself in total need of help for medication prescriptions, the Pharmaceutical Manufacturers Association offers over 63 programs to help you afford your medications. Contact PMA at 1-800-762-4636 or 1-202-393-5200.
PMA can help reduce any medications practically and the more you save in prescription costs, the more you can purchase fruits and vegetables and eat healthy! Or you can purchase a copy of my book, "Cooling Well Water: A Collection of Work By An African-American Bipolar Woman" ISBN 13 978-0-9754612-0-4 which contains a handy list of useful websites and information in addition to my own story of deliverance:).
Remember, also, that your doctor may have free samples sitting in a cabinet that will expire. Don't be too shy to ask for those samples as they will be thrown away on the expiration date!!
Have you heard about MedBankUSA? This is a national discount prescription plan available all over the U.S. and provides discounts on ALL drugs FDA-approved prescriptions drugs!! There is NO limited drug lists, too! You can use this discount card at almost any pharmace and each member of yuor family can use the same card. There is no fuss paperwork to worry about. Simply contact 1-877-435-7755 or visit MedBankUSA at
www.medbankus.org Meanwhile, please continue to support healthcare reform because this is one of the reasons that a public program is necessary and to end the way health insurance companies allow families to starve and file bankruptcy or suffer over the cost of medications in the U.S.
The National Alliance on Mental Illness supports MedBankUSA!:)
www.namimetropolitanbaltimore.org Agnes B. Levine
Author of: "Cooling Well Water: A Collection of Work By An
African-American Bipolar Woman" ISBN 13 978-0-9754612-0-4
Available NOW at
www.Amazon.com
Posted By: agnes levine
Monday, August 10th 2009 at 7:31PM
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