Dounut Hole

Oh....the God foresaken donut hole.
I am an insurance agent and I know all too well what a pain this is for some people.
I would speak to her pharmacy and ask them what they say about it. It may be the manufacturer doesn't want someone using the coupons if they are already getting a discount by virtue of Part D, but she isn't receiving the discount now.

I don't know how long she will have to take this medication, but there are open enrollment periods during which she can change her Part D plan. October is a good time to begin researching the different plans so she can be ready to submit the application necessary to change. Some plans provide coverage through the donut hole. They are more expensive per month, but with a drug this expensive, it would be worth looking into.

You can go to www.medicare.gov and enter her medications and the dosages to find out which plans are the most cost effective depending on her medications. You can also find preferred pharmacies for her plan and compare what the pharmacies themselves charge. They don't all charge the same. You should also be able to figure out exactly how long she will be in the donut hole before the price of the medication drops significantly. At $1,000 per month, hopefully it won't take long.

Definitely talk to the pharmacy and see what they say. If you need any more assistance, please let me know.
I am not working right now, so I'm not affiliated with any agency or insurance carrier whatsoever.
But, I can help you navigate through the medicare website to find lots of valuable information.

Best wishes!

1 mom found this helpful

I would call the insurance/Medicare office and ask them. Or, call your doctor and ask him...............The pharmacy may know the answer as well.

Good Luck.......

This is a huge debate in pharmacy-land. Some pharmacies may take it, not realizing the law. Even if she is in the doughnut hole, she is still a medicare recipient. Therefore, she is not eligible. So basically, Yes, the coupon MIGHT work because it will not be submitted to Medicare. BUT, legally, the pharmacy is not suppose to do that. By taking the coupon the pharmacy is committing Medicare Fraud. She can check with the Novartis patient assistance program to see if they have any special programs for Medicare Part D patients 800.277.2254

I would check with your pharmacy.

I'd call the pharmacy and ask to talk to the pharmacist on duty. Tell him/her what is going on and what do they do w/this situation. Hope this helps!
S.