The Cost of Enbrel and Medicare Part D by:Kirby Horton

For most seniors who live on a fixed income, Medicare Part D has been the answer to their prayer

. However, for those seniors who have a chronic condition, the Medicare Part D "donut hole" can be a startling realization. At this time of year there is much talk about the donut hole or coverage gap. What is it, why is it there, and how does it work?

Medicare's Part D cost was reduced by creating the coverage gap. The yearly limit for Part D is determined each year. The yearly amount in 2007 was $2400. In 2008, the yearly amount was increased to $2510. $2700 is the amount in 2009. The limit is calculated on the total costs of the drugs that you receive. This includes what the insurance company pays and your co-pays. For example, if a prescription medication is priced at $550 and the insurance company pays $500 and the patient pays $50, the amount that goes towards the yearly limit is the enire $550 the annual limit is the full $550.

You are responsible for all of your prescriptions during the time you are in the coverage gap. There are a lot of Medicare part D plans that provide coverage for generics when you are in the donut hole or coverage gap. The cost of most generics is so small that the benefit of having them covered by a Part D plan is not that much of a benefit. For some patients it could be worth it to have prescription coverage for generics, everyone's situation is different.

For Medicare people with chronic conditions which often require costly drugs for treatment, the coverage gap can be reached in a matter of weeks. Reaching the donut hole or coverage gap as early as February is not uncommon. The point for the donut hole or coverage gap was to steer people to use cheaper pharmaceuticals when possible. Because nothing else works it punishes those patients who must use expensive prescriptions. Enbrel is a medication for people who have rheumatoid arthritis and the price of it can cause the patient to reach the donut hole or coverage gap within two to three months. Then, they must pay for their prescriptions at full cost for several months until the catastrophic coverage portion of Part D kicks in, or suffer the potentially disabling consequences of stopping their medications. The cost of Enbrel is roughly $50 per day. Very few seniors can actually afford that.

Some patients will be able to take advantage of patient assistance programs due to their lower income. Going directly to the manufacturer can be most helpful in getting low or no cost drugs. Contact the company and ask about their Prescription Assistance Program. Most all pharmaceutical companies offer these programs, which enable consumers to receive prescription medicine they need at a price they can afford. A lengthy application co-signed by your healthcare provider is typically necessary for entry into the program. Patient Assistance Programs run by manufacturers have been in existence for over 21 years. These programs are designed to assist eligible people who can't afford their prescription medications due to limited income or other financial problems.

Manufacturers did not want their low income patients 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, few patients knew about the existence of these programs or could follow the complicated application process that was required for participation. In many cases multiple applications had to be filed with several different pharmaceutical companies in order to gain access to assistance programs.

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

About the author

Do you need prescription drug help? Kirby Horton has been helping Americans with their healthcare needs for close to 30 years. He is the Founder of Rx Help, a Prescription Assistance Company. He can be reached at 866-960-9497 and you can follow his blog at http://rxhelp4u.wordpress.com

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