FAQ: Prescription Drug Assistance

What options are available to help me reduce the cost of my medications?
Each year there are several Medicare Part D plan options so choosing a plan should be based upon your current medication list. This choice can be made annually so if medications change so can your plan. Patient assistance or financial programs can help.

What is Medicare Part D prescription drug coverage?
Private insurance companies contract with Medicare on a yearly basis to offer coverage for medications under several plan choices. Most plans offer nationwide coverage.

How does it work?
It works by signing up for a plan and agreeing to monthly premium payments either during your initial enrollment period or annually during open enrollment after which coverage will start based upon Medicare’s guidelines. You also have the ability to select among several pharmacies.

Can I review or change my Medicare Part D prescription drug plan annually?
Yes. We recommend at least an annual review to check for any savings. Under certain circumstances changes can even be made more often under special enrollment criteria.

Why?
Private insurance companies compete for your business and changes in plans occur annually. The pharmacies may choose which plans they will accept and this can change annually. Your health, medications, or other circumstances may change during the year so you are allowed by Medicare to look at plan options based upon these changes at least annually.

Is there a cost advantage to use mail order?
Maybe. In the past, quantity restrictions on retail pharmacies made the mail order option more attractive. Today however, many plans offer longer supplies of medications through local retail pharmacies at similar if not the same price as the mail order option.

What if my insurance won’t pay for a medication?
It is necessary to find out why the insurance won’t pay for a medication. Today there are three areas of restrictions and it doesn’t always mean insurance will not allow the use of a particular medication.

What is the ‘donut hole’ or coverage gap?
When the Medicare Part D plan concept was first introduced, patients were expected to pay more for their medications after a certain dollar amount. This is known as the ‘donut hole’ or coverage gap. The dollar amounts set by Medicare causing someone to fall into and then get out of the coverage gap change yearly. Eventually the coverage gap will close completely. However, Medicare will still expect the patient to pay about 25% of their prescription costs.

Are there options for financial assistance to help with the cost of my medications?
Yes. Most individuals may think of Medicaid as the only option which is not true. Although there are income restrictions to most, several options include low income subsidy (LIS) through Social Security, Medicare savings programs, manufacture patient assistance, foundations, and the Wyoming Prescription Donation program for possible help.

Can you help with non-Medicare prescription insurance issues?
Yes. Many of the prescription issues by private insurance companies outside of Medicare are very similar in nature.

 

Click the links below for other FAQs

General FAQ

What is a Patient Advocate?

What is an Insurance Consultant?

FAQ: New to Medicare

FAQ: Patients and Family

FAQ: Healthcare Professionals

FAQ: Businesses

 

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