topic Donut Hole in Community Chat

Donut Hole

nagrom — Fri, 30 Sep 2016 04:12:16 GMT

Yea! I am now officially out of the donut hole. Every other year I experience this. Now for the rest of the year my meds are cheaper. I also try to stock up at the end of the year so next year will not need certain 90 day prescriptions until March.

Does anyone else manage their meds this way too? If we had reasonable prices for our prescriptions like Canada does we would never think of ways to save money like this.

Re: Donut Hole

chessylady — Fri, 30 Sep 2016 06:03:35 GMT

I have Medicare advantage through an HMO. My prescriptions cost $10 out of pocket unless it is not on their formulary.

Re: Donut Hole

nagrom — Fri, 30 Sep 2016 06:56:42 GMT

I have a Medicare advantage plan as well but some of the scripts are costly. For example the Advair diskus runs over $500 for a three month supply. Then there are other things like insulin that run another $423 for one and $250 for another. The test strips run $1.00 per strip and the insurance covers a portion so it runs about $178. Regular scripts could run $10 but it's the other than is so high. Nasal spray runs $38 a month. I could go on......some of my meds are very old but the price has skyrocketed. Humalog is one. You hear about people complaining about the epi pen but the insulin and asthma meds are that and more....a friend has only one kidney and her spleen was removed. Her one med runs $1000 a month. No discount...not all plans cover different type of meds.

Re: Donut Hole

hckynut — Fri, 30 Sep 2016 07:43:25 GMT

Neither Medicare or my Secondary Insurer are involved in my prescriptions. That is a completely separate program from my Medical Insurers. It is paid for as on of my retirement benefits after my 33 years with the company.

They are now all generics(but were not for many years), so the cost is much less. Highest price is $25 for 90 days for 2 of my prescriptions. The others range from $2.25 to $10. It for me is a good program that was much more expensive before the plan switched and promoted mail order 90 day prescriptions.

hckynut(john)

Re: Donut Hole

AngelPuppy1 — Fri, 30 Sep 2016 09:26:37 GMT

@nagrom wrote:
Yea! I am now officially out of the donut hole. Every other year I experience this. Now for the rest of the year my meds are cheaper. I also try to stock up at the end of the year so next year will not need certain 90 day prescriptions until March.

Does anyone else manage their meds this way too? If we had reasonable prices for our prescriptions like Canada does we would never think of ways to save money like this.

@nagrom

Yes, my husband just did this, too; his scripts are atrociously expensive. It's a crime, really.

Re: Donut Hole

AngelPuppy1 — Fri, 30 Sep 2016 09:28:46 GMT

@nagrom wrote:
I have a Medicare advantage plan as well but some of the scripts are costly. For example the Advair diskus runs over $500 for a three month supply. Then there are other things like insulin that run another $423 for one and $250 for another. The test strips run $1.00 per strip and the insurance covers a portion so it runs about $178. Regular scripts could run $10 but it's the other than is so high. Nasal spray runs $38 a month. I could go on......some of my meds are very old but the price has skyrocketed. Humalog is one. You hear about people complaining about the epi pen but the insulin and asthma meds are that and more....a friend has only one kidney and her spleen was removed. Her one med runs $1000 a month. No discount...not all plans cover different type of meds.

@nagrom

Same here. DH has to purchase all of these diabetic supplies and things for his COPD. These things are atrociously over-priced and it makes me so mad! I mean, he has to have these things to survive! You have no choice. So much for the golden years. What gold? They make sure you have not one cent left to your name after you finish paying for all of this cra*p!!!!

Re: Donut Hole

gidgetgh — Fri, 30 Sep 2016 10:34:55 GMT

@nagrom wrote:
Yea! I am now officially out of the donut hole. Every other year I experience this. Now for the rest of the year my meds are cheaper. I also try to stock up at the end of the year so next year will not need certain 90 day prescriptions until March.

Does anyone else manage their meds this way too? If we had reasonable prices for our prescriptions like Canada does we would never think of ways to save money like this.

My husband is out of the doughnut hole also. Yipee!!! Stock up time for us also. He has Parkinson's and his meds are pretty darn expensive, but not when he's out of the dougnut hole. We use mail order for his meds and I refill the minute I'm able to.

Re: Donut Hole

Imadickens — Fri, 30 Sep 2016 10:58:14 GMT

Help, please. What is the donut hole?

Re: Donut Hole

nagrom — Fri, 30 Sep 2016 13:43:58 GMT

The donut hole is a stage of payment when you have paid $3310 for your copays for prescriptions for the year 2016. This is stage 3. The costs of prescriptions then become very costly until you have paid $4850. Then you move out of the donut hole and your meds are very reasonable through the end of the year. Many meds cost 5% in this phase.

Prescription copays are very reasonable for tier 1 and Tier 2 drugs. Tier 3, 4 and 5 meds are very well expensive. I am asthmatic and the inhalers are extremely expensive as are my diabetic insulin and supplies. I am unable to take the cheaper diabetic meds as I have allergic reactions. Thus I was forced to go on insulin. The needles and testing strips are outrageously expensive. For folks like me there is no choice with the meds we are on.

Re: Donut Hole

nagrom — Fri, 30 Sep 2016 14:03:32 GMT

I tried to purchase a meter and test strips from Amazon.com through a Canadian supplier. Cost was very reasonable and I thought it was the way to go until I got an email notice stating the test strips were being recalled. I don't remember why it was recalled but I just had used up all of my order of strips......Now I doubt I will try that again.

My insurance will only cover a certain brand of meters and test strips. I was forced to buy a new meter and test strips. Now I got my 2017 Medicare booklet. My Humalog is no longer in their covered list of prescriptions. When I researched online there are websites stating the same. At this time I cannot find replacement information. I take Humalog for short term and lantus for long term. Other insulin such as levemir and humulin cause reactions and am unable to take them. Will try to find out what will be covered . Grrr

Re: Donut Hole

goldensrbest — Fri, 30 Sep 2016 17:54:20 GMT

@nagrom wrote:
The donut hole is a stage of payment when you have paid $3310 for your copays for prescriptions for the year 2016. This is stage 3. The costs of prescriptions then become very costly until you have paid $4850. Then you move out of the donut hole and your meds are very reasonable through the end of the year. Many meds cost 5% in this phase.

Prescription copays are very reasonable for tier 1 and Tier 2 drugs. Tier 3, 4 and 5 meds are very well expensive. I am asthmatic and the inhalers are extremely expensive as are my diabetic insulin and supplies. I am unable to take the cheaper diabetic meds as I have allergic reactions. Thus I was forced to go on insulin. The needles and testing strips are outrageously expensive. For folks like me there is no choice with the meds we are on.

Are you saying that you have to pay ,out of pocket the $3310?

Re: Donut Hole

mima — Fri, 30 Sep 2016 18:04:48 GMT

@goldensrbest wrote:
@nagrom wrote:
The donut hole is a stage of payment when you have paid $3310 for your copays for prescriptions for the year 2016. This is stage 3. The costs of prescriptions then become very costly until you have paid $4850. Then you move out of the donut hole and your meds are very reasonable through the end of the year. Many meds cost 5% in this phase.

Prescription copays are very reasonable for tier 1 and Tier 2 drugs. Tier 3, 4 and 5 meds are very well expensive. I am asthmatic and the inhalers are extremely expensive as are my diabetic insulin and supplies. I am unable to take the cheaper diabetic meds as I have allergic reactions. Thus I was forced to go on insulin. The needles and testing strips are outrageously expensive. For folks like me there is no choice with the meds we are on.
Are you saying that you have to pay ,out of pocket the $3310?

I'm confused too. Do you pay $3310 or $4850 out of pocket per year? Yikes!

Re: Donut Hole

nagrom — Fri, 30 Sep 2016 18:24:24 GMT

Yes your out of pocket is $4850 for this year. I think it may be $5000 next year. My Humalog says it used to be $47 fifteen years ago. And now $1400 or there abouts now. This is an old drug and been around for years. There are plenty of other drugs that are the same. Canadian pharmacy does not offer it as an option either.

Re: Donut Hole

momtochloe — Fri, 30 Sep 2016 18:31:51 GMT

@hckynut wrote:

Neither Medicare or my Secondary Insurer are involved in my prescriptions. That is a completely separate program from my Medical Insurers. It is paid for as on of my retirement benefits after my 33 years with the company.

They are now all generics(but were not for many years), so the cost is much less. Highest price is $25 for 90 days for 2 of my prescriptions. The others range from $2.25 to $10. It for me is a good program that was much more expensive before the plan switched and promoted mail order 90 day prescriptions.

hckynut(john)

@hckynut I know you were involved in the painful break up of the Bells back in the day but I would ask who actually eventually covered your medical coverage and were unions involved?

Re: Donut Hole

151949 — Fri, 30 Sep 2016 18:34:04 GMT

I am fortunate to take only 3 Rx drugs and they are all tier 1. By the end of the year I will have only paid about $72 in copays.This is one reason we are better off on an advantage plan than a supplement.

Re: Donut Hole

SharkE — Fri, 30 Sep 2016 18:41:24 GMT

I've been paying 528 a month on just me monthly for Humana private pay policy. Husband on Medicare.

Well, today, I got a letter saying it's went up 22% and now the new payment will be 650. I just smiled................

I'll be 65 in Dec.

Bye,bye Humana !!

p.s. always paid by check, no withdrawal or charging any acct. either

Re: Donut Hole

NickNack — Fri, 30 Sep 2016 18:40:38 GMT

@goldensrbest wrote:
@nagrom wrote:
The donut hole is a stage of payment when you have paid $3310 for your copays for prescriptions for the year 2016. This is stage 3. The costs of prescriptions then become very costly until you have paid $4850. Then you move out of the donut hole and your meds are very reasonable through the end of the year. Many meds cost 5% in this phase.

Prescription copays are very reasonable for tier 1 and Tier 2 drugs. Tier 3, 4 and 5 meds are very well expensive. I am asthmatic and the inhalers are extremely expensive as are my diabetic insulin and supplies. I am unable to take the cheaper diabetic meds as I have allergic reactions. Thus I was forced to go on insulin. The needles and testing strips are outrageously expensive. For folks like me there is no choice with the meds we are on.
Are you saying that you have to pay ,out of pocket the $3310?

@goldensrbest and @mima Here's an excerpt from Medicare's website about the donut hole coverage gap.

Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2016, once you and your plan have spent $3,310 on covered drugs, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Re: Donut Hole

nagrom — Fri, 30 Sep 2016 18:46:57 GMT

I am on an advantage plan. I have Tier 3 meds. The Tier 1 and Tier 2 are not costly. Tier 3 and above are horribly expensive.

Who would ever think when you are eligible for Medicare that your prescriptions would run so high. Now the government is talking about giving you a voucher instead of Medicare that you could bargain and purchase your own care. No controls about price gouging for prescriptions.

Re: Donut Hole

deepwaterdotter — Fri, 30 Sep 2016 18:49:32 GMT

We are covered by a plan similar to hockeynut (John).

Re: Donut Hole

nagrom — Fri, 30 Sep 2016 19:16:52 GMT

Looks like it is better through a Bell company than an insurance company. My Canadian Bell friends got a sweet deal for their retirement. Canada has national healthcare so they received phone benefits and I believe pension lump sums.