QUESTION:  I am new to Medicare, how do I maximize my Part D drug plan benefits and get the most savings on my medications?

ANSWER:  I am going to walk you through step-by-step of how to get the most savings out of your drug plan. 

1.  Before you enroll on a Part D drug plan, the very first thing you need to get is a comparison of the Part D plans, based on your individual medications, so that you know what plans cover your drugs and which plan will save you the most in co-pays and premiums.  We can help you with your comparison anytime of the year, if you are just getting on Medicare or have lost your coverage through your retirement program.  After that, you will need to get a comparison once every year during the AEP, or Annual Enrollment Period of November 15 thru December 31st.  This is the time of year that you can change your drug plan, making sure that you continue to have your drugs covered at the lowest prices.  All the drug plans change the drugs they cover on their formulary and the prices they will charge you every year!  Don’t make the mistake of just “keeping what you have”.  Your loyalty will cost you!  YOU NEED TO FIND THE PLAN THAT WILL SAVE YOU THE MOST IN CO-PAY’S AND PREMIUMS ON THE FIRST 2,700 DOLLARS OF YOUR PLANS BENEFIT BEFORE THE “DREADED DONUT HOLE” IN 2009.

2.  January 1st of every year your Part D drug plan benefits start over.  You will have to purchase $2,700 worth of medications before you fall into the “dreaded donut hole” in 2009.  This is not the co-pay costs, but the RETAIL COSTS are used to add up your purchases.  To maximize your benefits you can begin by NOT purchasing as many of your generic drug as possible using your drug plan.  WHY?  Wal-Mart and some other large retailers have a list of over 300 generic drugs that they sell for $4 for a 30-day supply.  If you email me, I will send you this list.  If you don’t like using Wal-Mart for some reason, many chain drug stores are doing this as well.  Check with them and buy them without using your drug plan, don’t give them your drug plan card and tell the pharmacy this is not to be added to your drug plan coverage.

The reason for this is that every prescription you purchase goes toward the “dreaded donut hole”.  If you purchase your generics off your drug plan, you will have more money left in the pot to pay for your expensive medications, thereby keeping you OUT of the “dreaded donut hole” longer!  Also, when your doctor prescribes a NEW drug for you, tell him/her then and there that you need to use the older tried and true meds, instead of the new designer drugs that are so expensive, IF your doctor feels like you will be able to get the same results.  For those of you that love Sally Field (I DO) and the other celebrities that sell designer drugs and you want to help the drug companies pay their huge salaries for their endorsement (I DON’T), please ignore this advice.  HA! Then tell him/her you need to take samples first, to make sure this drug will work for you.  You would not believe how many prescriptions people get each year that go toward their “dreaded donut hole” and they end up NOT EVEN TAKING THEM, BECAUSE THEY DON’T LIKE THE SIDE-EFFECTS, OR THEY SIMPLY DON’T WORK FOR THEM.  This will keep you out of the donut hole longer as well!

3.  The only folks who need to be concerned about what happens when they hit the “dreaded donut hole” are the folks who know they WILL get to the other side and begin the catastrophic coverage of 95%.  Most people don’t fall into the donut hole.  The rest fall in and never reach the other side.  If you fall into either of those categories, you should STOP USING YOUR DRUG PLAN when you reach the donut hole.  You MUST continue to pay your monthly premiums so you won’t have a penalty, but THERE IS NO NEED TO PAY MORE FOR YOUR MEDICATIONS THAN YOU ABSOLUTELY HAVE TO PAY!!  You will need to do a little research at this point and call your pharmacist and other drug stores to see how much your medications will cost using your drug card, and how much they would cost without using it.  Many of the drug plans charge you a higher retail price while you are in the “dreaded donut hole” to make up for loses they incurred while you were on the much cheaper co-pays amounts.  YOU CAN BUY OR ORDER YOUR MEDICATIONS ANYWHERE YOU CAN FIND THEM CHEAPER!!  You can’t afford to be loyal to your drug plan as they are not loyal to you!

4.  If you have serious on-going health problems and know that you take so many medications that you will ACTUALLY fall into the donut hole and make it across to the 95% catastrophic coverage, YOU MUST CONTINUE TO USE YOUR PART D DRUG PLAN CARD SO THAT ALL THE MEDICATIONS YOU PURCHASE GO TOWARD YOUR GETTING OUT OF THE DONUT HOLE. 

Now, please read my other drug savings tips and donut hole advice by clicking on them in the category section on the left side of this page!  I have much more to tell you!

I hope this answered your question, if not, please write to me, Karyn Blake, and I will find an answer for you ASAP.

Do you have several different doctors that you see for your healthcare? 

If so, please be aware that you need to tell every doctor you see about ALL the prescriptions you take.  Many times we find that people have too many prescriptions for the same health problem.  If one doctor prescribes a medication for you and you do not share this with the other doctors that care for you, duplicate prescriptions can occur. 

The average senior citizen takes 4 to 6 different kinds of prescriptions a day and refills their meds 12 to 17 times a year.  Can you imagine how much you could save if you made sure every prescription was actually NEEDED!  As you know EVERY PRESCRIPTION YOU GET FILLED GOES TOWARD YOUR FALLING INTO THE “DONUT HOLE”. 

We see many people taking several kinds of medications that treat the same ailment.  Sometimes this is necessary, but many times it is not.  Be sure you discuss all your meds with every doctor you see!!  If you are not taking the generic form, ask the doctor if you can switch.  Ask your doctor if there is a less expensive medication for your problem.  Many times doctors will prescribe the newest most expensive medications instead of the old tried and true less expensive meds.  Don’t be shy to explain to your doctor you MUST SAVE AS MUCH AS POSSIBLE ON YOUR MEDS!!

Anytime your doctor gives you a NEW medication, ask him to give you samples to take at first.  Many times the NEW medication will not work for you.  If you have filled a complete prescription for this medication IT WILL COUNT TOWARDS YOUR FALLING INTO THE “DONUT HOLE”.  I can’t tell you how often this happens, so please do yourself a favor and don’t be afraid to ASK FOR SAMPLES TILL YOU ARE SURE THIS NEW MEDICATION WORKS FOR YOU!!

If you are in the “donut hole” or cannot pay for your expensive medications you may want to try to contact the actual drug manufactuer to see if you qualify to get help from them. 

Pharmaceutical companies offer assistance programs for the drugs they make.  To see if any programs are available for the drugs you are taking, please go to the CMS medicare Part D webpage http://www.medicare.gov/pap/index.asp  select the letter in the list provided to see if your drug is on the list.  If your drug is on the list, click on the link labeled “details” for detailed information about the program.

Also, there are some states that offer help with paying drug plan premiums and/or other drug costs.  You can find out if your State has a program by visiting the CMS State Pharmaceutical Assistance Program site at http://www.medicare.gov/spap.asp

If you have had an experience with getting help this way, we would like to hear from you.  It helps other people to know what you have gone through.  You can write me by using the link at the top right corner of this site.

QUESTION:  I HAVE BEEN APPROACHED BY A SALESPERSON TO GET A “DISCOUNT DRUG CARD”.  HE SAYS IT IS BETTER THAN PART D.  SHOULD I LOOK INTO GETTING THIS CARD?

ANSWER:  There are many “discount drug card” offers out there floating around.  Although some of these cards could save you some money, you should be aware that some cards are scams and other won’t save you as much as they say they will.  Be aware that drug discount cards are NOT the same thing as your Part D Drug Insurance Plan.  You must call your pharmacy to see if they even honor the card, before you join.  Be wary of drug discount cards that charge a FEE, and watch out for hidden costs.  You should NOT pay a fee to recieve a discount.

I have heard of a drug card from United Networks of America called Texas Rx Card.  It is free and does offer discounts on several common prescriptions.  You may have a simular card in your state.  Walgreens and Kmart accept this card. 

Just be careful and don’t pay any fees for a discount card.  Check with your pharmacy to see if they accept it and you should be okay.

QUESTION:
I AM ELIGIBLE FOR EXTRA HELP TO PAY FOR MY MEDICARE PART D EXPENSES. EVERY YEAR THEY SEND ME A FORM THAT I HAVE TO FILL OUT IN ORDER TO CONTINUE MY BENEFIT. WHY IS THIS NECESSARY? MY INCOME DOES NOT CHANGE.

ANSWER:
THE SOCIAL SECURITY ADMINISTRATION IS REQUIRED BY LAW TO VERIFY ANNUALLY THAT BENEFICIARIES WHO ARE CURRENTLY RECEIVING THE LOW-INCOME SUBSIDY ARE STILL ELIGIBLE FOR THAT SUBSIDY. THIS IS CALLED THE REDETERMINATION PROCESS. IF YOU HAVE APPLIED FOR AND HAVE BEEN QUALIFIED FOR MEDICARE DRUG ASSISTANCE PROGRAMS, FEDERAL OR STATE, YOU MUST RE-APPLY EVERY YEAR. THEY WILL SEND YOU A FORM ONCE A YEAR THAT MUST BE RETURNED, OR YOU WILL BE WITHOUT YOUR ASSISTANCE THE FOLLOWING YEAR BEGINING APRIL 1.

WE HAVE BEEN GETTING CALLS FROM MANY PEOPLE WHO DID NOT REPLY TO THE LETTER AND THEY DID NOT SEND BACK THEIR FORMS TO SOCIAL SECURITY AND NOW THEY HAVE LOST THE HELP THEY HAD TO PAY FOR THEIR MEDICATIONS.

IF THIS HAS HAPPENED TO YOU WE CAN RE-SUBMIT THE FORMS FOR YOU TO RE-APPLY!! CALL TOLL FREE 866-752-1795.

IF YOU HAVE INCOME BELOW:

SINGLE - 15,600

YOU MAY QUALIFY FOR “EXTRA HELP” TO PAY FOR YOUR MEDICATIONS.

Reading online I came across a recent study about generic medications and how people react to them.

Many people believe that the higher the price of a medication the better it works for them. They feel that when they get a generic it couldn’t possibly work as well as the brand name drug.

In a study of 82 healthy participants, they were given a light electric shock and then an identical placebo pill to relieve the pain. Half of the participants were told that the pills they were given were similar to codeine and cost $2.50 per pill. The other half was given the same information, except that they were told their medication cost only 10 cents per pill.

About 85% of the participants who took the placebo that researchers said cost $2.50 per pill reported pain relief, compared with 61% who took the pill that cost only 10 cents.

According to Consumer Reports, generic drugs are just as safe as their brand-name counterparts and work just as well for most people, AND they are much cheaper. Generic durgs save consumers $8 to $10 billion dollars at the pharmacy each year.

We have given much advice on this blog about switching to a generic form of your medication if it is available and if it works well for you. Please check at Wal-Mart and other large retailers for their lists of generics for $4 for a 30 day supply. You can do this WITHOUT USING YOUR DRUG PLAN CARD. This one tip alone could keep you OUT OF THE DONUT HOLE, for months longer. If you buy generics off your plan, it does not count toward the donut hole!!

At My Part D USA, we try to keep you informed of ways to save the most on your medications. Please read my other blogs about drug savings tips under the categories list on the left side of this page.

If you have any questions you can always reach me, Karyn Blake, toll free at 800-752-1795.

Also, if you have any stories or advice to share with our readers about your experiences with your drug plan or savings tips please send them to me at:

kblake@MyPartDusa.org

Yesterday a reader wrote in with a question about her Lotrel, a blood pressure medication. She was taking 1 pill per day. Her Doctor then prescribed 2 pills per day to control her condition. This had caused her drug plan to charge her for 2 co-payments for the same prescription and she was wondering how they could do this.

Every drug plan arbitrarily decides what they consider a “normal” 30 day dosage for each medication would be….or what a doctor would normally prescribe to control each illness. If your individual prescription goes over this “normal” range, the drug plan will charge you for two 30 day supplies, or 2 co-payments, even though your doctor says you need them.

You do have a recourse however, by requesting your Doctor write your drug plan a “letter of exception”. He can state in the letter that for YOU and YOUR CONDITION a 30 day supply is 2 pills per day instead of just one.

After your doctor writes the letter for you, call your drug plan’s customer service number and ask if you should fax it to them and get the fax number OR if you should send the original copy to them in the mail. ALWAYS KEEP A COPY FOR YOURSELF OF ALL CORRESPONDENCE SENT TO YOUR DRUG PLAN.

Once the drug plan receives your letter, they have 72 hours to respond.

If they deny the doctor’s request, you can appeal. Also, there are free lawyers that will take your case by contacting
Medicare Rights Center at
MedicareRightsCenter.org and clicking on Medicare Law.

As we all know Americans take more prescription drugs than many other countries combined. WHY? One reason is that the drug companies have huge marketing budgets to advertise on TV and to give expensive trips and gifts to Doctors to prescribe the many different medications on the market. Just last night on the news, it was reported that a study of Zetia and Vytorin concluded that it does nothing to prevent the build up of cholesterol and plaque in your heart to prevent heart associated illness. So, how can we as consumers educate ourselves so that we DON’T TAKE MEDICATIONS THAT WE DON’T EVEN NEED?

That is the million dollar question! Several states, including Pennsylvania and South Carolina, have hired their own representatives to call on doctors and discuss older drugs and generics. The idea is to counter the pitches and gift giving of the drug industry sales reps who are promoting their company’s latest, most expensive drugs. This could restore a sense of “medical ethics”.

No one would deny that new drugs have saved lives, however, new medications are much more expensive when you could be taking tried and true older drugs that would do the same thing for less money to the consumer. One such example is a drug for bone strength called Boniva. The big selling point is that you only have to take it once a month. The older medication that is less expensive is called Fosamax, which is taken once a week. I can imagine with all the other pills people take, this shouldn’t be much of a selling point, but that just goes to show how these drug companies can take NOTHING and sell it to you for more than you need to pay. It has also been shown that Fosamax has other values to your health that Boniva does not have. But as always, YOU MUST CHECK WITH YOUR DOCTOR TO SEE WHICH DRUG IS RIGHT FOR YOU!

Don’t be shy to explain to your doctor that you NEED to take drugs that are less expensive. Ask if there are older drugs that could help you, instead of the new designer drugs being promoted so heavily.

Each day more than 101,000 drug reps - one for every 5 office based physicians call on the nations doctors. Primary care physicians have about 28 interactions a week with drug sales people! Isn’t that amazing!

Remember that YOU ARE THE BOSS OF YOU! Make sure that you tell your doctor EVERY drug you are taking, even if you got that prescription from another physician. Every doctor you see needs to know EVERY drug you take. This will prevent over prescribing and make sure all your drugs interact to best help you live life to its fullest. That is the main goal with medication, to help you maintain your health and enjoy living!

If you have any question about this blog or would like me to research any topic for you, please write me, Karyn Blake:

kblake@MyPartDusa.org