How do you help Medicare patients who have reached their donut hole?

[RxPal]

More and more patients at our pharmacy are seeing a sudden increase in their copays. I assume they have reached the Medicare Part D donut hole. Their incomes are not low enough to qualify for Medicaid. But all the sudden having to pay $100 each month for a maintenance inhaler really eats into their monthly budgets, especially for the elderly. I have tried running different alternatives, but I am not always able to find more affordable options. Federal law does not allow Medicare patients to use manufacturer coupons.

How do you help your Medicare patients with high copays?

---

Members don't see this ad.

 

[Sine Cura]

I don't since 95% of them have Extra Help

 

[lord999]

Spend, baby, spend! More helpfully, find a gap insurance policy, but that's a tradeoff too.

 

[CetiAlphaFive]

Tell them to pay attention the next time they're selecting a Part D plan and not just select the lowest premium

 

[wagrxm2000]

First time sucks but they will learn and plan ahead next year.

 

[trailerpark]

Don’t RSVP to any pity parties. Tell them you graduated with a quarter of a million dollars in debt.

 

[Drugsarefun2350]

More and more patients at our pharmacy are seeing a sudden increase in their copays. I assume they have reached the Medicare Part D donut hole. Their incomes are not low enough to qualify for Medicaid. But all the sudden having to pay $100 each month for a maintenance inhaler really eats into their monthly budgets, especially for the elderly. I have tried running different alternatives, but I am not always able to find more affordable options. Federal law does not allow Medicare patients to use manufacturer coupons.

How do you help your Medicare patients with high copays?

Let them suffer

 

[BenJammin]

I hope no one helps these patients. Medicare Part D patients need to pay into the system for solvency. This is a two way street.

 

[RxPal]

The patients I am trying to help are nice, respectful elderly customers who have placed their trust in me. Unfortunately, there’s not much a pharmacist can do when it comes to copays in our current healthcare structure. Everyday I keep telling people around me either don’t get old or do whatever they can to stay healthy, or they will end up spending a big chunk of their retirement money on medications rather than life enjoyment.

 

[MrBonita]

If possible tell them to use the walmart 4 dollar plan on some drugs or use costco as they offer cheap prices.

 

[RxPreceptor]

#Self responsibility
You are not their financial planner, often times, people need to learn things the hard way. No one has time for this **** nor should we be constantly wiping their @$$ for them

 

[Wickett]

My company offers to look at patient med lists, shop around Med B plans, then give them a report that shows which plans cover their particular meds the best. Not much else I can recommend other than to try and switch them to alternatives with generics, if possible, then recommend they use our service the next enrollment period to get better coverage. Even then, most people don't take me up on the offer to compare new plans, they sign up on their own, then complain to me again the next year when they hit the coverage gap by early summer the following year. Old people tend to just blindly sign up for the plan that has the lowest monthly premium and do no research on the actual coverage of that plan. You can lead a horse to water....

 

[deleted945127]

If it is brand name med ..i google the manufacturer and see if they have phone no.
Ask pt to call them and check if they have some discount to help medicare part D


Sometime it works ,it worth the try

 

[angelsplight]

If they are on insulin and inhalers for COPD, not much you can do. I know a couple of patients rely on free samples at the doctors office once they reach that donut hole since they year is about to end anyways but there are those who I see enter the donut whole like early April and in that situation...Pay up, not much you can do.

 

[owlegrad]

Some misguided people will reverse the claim and rebill it to a discount card. Besides any other issues the amount they pay for the inhaler won't go towards getting them out of the donut hole. The best thing they can do is just pay for the inhalers until they get out the other side. There might be ways to save in the short run but if they don't get out of the donut hole they are screwed for the rest of the year.

I do recall one interesting experience I had at CVS. A claim had been billed for something ludicrously expensive, say Humara. Well that one claim alone got the patient out of the donut hole, so the rest of their meds were the normal copay. Unsurprisingly the patient didn't pick up the Humara or whatever it was so once that claim was reversed the copay on their next refills were the sky hi donut hole prices. I always wondered what would happen if the patient kept "refilling" the Humana and then not picking it up - would he ever have to pay the donut hole prices?

 

[JustFillIt]

Tell them to pay attention the next time they're selecting a Part D plan and not just select the lowest premium

Ceti - this is a big turn around from your mansplaining, racist, and sexist post from last week. This gets a big approval from me!

 

[mydogatemysuboxone27]

Tell them to pay attention the next time they're selecting a Part D plan and not just select the lowest premium

This ^. If they have a Silverscript plan and they come to my WAG I recommend they look into AARP or Humana since those are preferred. I don't know if it would save them money at all but I tell them that it's worth a check.

 

[mydogatemysuboxone27]

The patients I am trying to help are nice, respectful elderly customers who have placed their trust in me. Unfortunately, there’s not much a pharmacist can do when it comes to copays in our current healthcare structure. Everyday I keep telling people around me either don’t get old or do whatever they can to stay healthy, or they will end up spending a big chunk of their retirement money on medications rather than life enjoyment.

I also try to go over their medicine and see if there's anything expensive.. if there is and there is an alternative that has a generic I talk to them about it. I also work in a very low volume store so I have the ability to do things like this

 

[CetiAlphaFive]

If it is brand name med ..i google the manufacturer and see if they have phone no.
Ask pt to call them and check if they have some discount to help medicare part D
Sometime it works ,it worth the try

It literally never works.
Either someone somewhere after you gets them set up somehow with a foundation to provide them with a medication funding grant, or the patient lies and signs up for manufacturer discount which you then illegally fill.

 

[CetiAlphaFive]

Some misguided people will reverse the claim and rebill it to a discount card. Besides any other issues the amount they pay for the inhaler won't go towards getting them out of the donut hole. The best thing they can do is just pay for the inhalers until they get out the other side. There might be ways to save in the short run but if they don't get out of the donut hole they are screwed for the rest of the year.

I do recall one interesting experience I had at CVS. A claim had been billed for something ludicrously expensive, say Humara. Well that one claim alone got the patient out of the donut hole, so the rest of their meds were the normal copay. Unsurprisingly the patient didn't pick up the Humara or whatever it was so once that claim was reversed the copay on their next refills were the sky hi donut hole prices. I always wondered what would happen if the patient kept "refilling" the Humana and then not picking it up - would he ever have to pay the donut hole prices?

https://i.imgur.com/HePlrbJ_d.jpg

 

[lord999]

Some misguided people will reverse the claim and rebill it to a discount card. Besides any other issues the amount they pay for the inhaler won't go towards getting them out of the donut hole. The best thing they can do is just pay for the inhalers until they get out the other side. There might be ways to save in the short run but if they don't get out of the donut hole they are screwed for the rest of the year.

I do recall one interesting experience I had at CVS. A claim had been billed for something ludicrously expensive, say Humara. Well that one claim alone got the patient out of the donut hole, so the rest of their meds were the normal copay. Unsurprisingly the patient didn't pick up the Humara or whatever it was so once that claim was reversed the copay on their next refills were the sky hi donut hole prices. I always wondered what would happen if the patient kept "refilling" the Humana and then not picking it up - would he ever have to pay the donut hole prices?

Like to earn some cheap money? Report that to CMS Fraud, and you can take home 20% of the $15k. I earned some chump change from CMS for something else posted here on the forums that was blatantly illegal.

 

[RxPreceptor]

Some misguided people will reverse the claim and rebill it to a discount card. Besides any other issues the amount they pay for the inhaler won't go towards getting them out of the donut hole. The best thing they can do is just pay for the inhalers until they get out the other side. There might be ways to save in the short run but if they don't get out of the donut hole they are screwed for the rest of the year.

I do recall one interesting experience I had at CVS. A claim had been billed for something ludicrously expensive, say Humara. Well that one claim alone got the patient out of the donut hole, so the rest of their meds were the normal copay. Unsurprisingly the patient didn't pick up the Humara or whatever it was so once that claim was reversed the copay on their next refills were the sky hi donut hole prices. I always wondered what would happen if the patient kept "refilling" the Humana and then not picking it up - would he ever have to pay the donut hole prices?

Exactly, looking @ the big picture for overall cost is what matters; too much nearsightedness & no planning or expectations of future costs is what resorts to many people looking for irrational ways to work around the system. Most common scenario = FXa inhibitors in the donut hole...will let people be aware of the PIA it would be to switch to warfarin and vice versa thinking there is some way to work the system. Often for Brand (mostly corticosteroid &/or anticholinergic combo products) inhalers, I have a lot of people just end of temporarily discontinuing them...><. Sucking up the albuterol though

#Instant gratification/Quick fix/nearsightedness or whatever you want to call it