The donut hole has been eliminated effective 2020. However, there are some ways you still may be able to reduce your out-of-pocket costs. For example, you may wish to talk to your doctor about the drugs you are currently taking to find out if there are generic or less-expensive brand-name drugs that would work just as well as the ones you’re taking now. You may also be able to save money by ordering your drugs through mail order pharmacies. It may also be possible to “split pills,” if you are taking a medication that is less expensive in higher dosage pills. It is extremely important, however, to make sure you are taking the full dosage of the medication prescribed by your doctor. “Pill splitting” that results in lower dosages of needed drugs could be hazardous to your health.
Another way to reduce your out-of-pocket costs is to find out if you are eligible to participate in any national or local charitable programs that help pay for drug costs. Expenses covered by many charities count toward the Part D out-of-pocket costs that help get you out of the donut hole.
Large retail stores often offer discounted drugs. If you use this option, check to make sure the store’s pharmacy is part of your plan’s network. If it isn’t, your expenditures on these drugs won’t count as Part D expenses that will help get you out of the coverage gap. However, it still may be worth it to buy some of your drugs from these stores and have your plan cover others.
A number of states offer State Pharmaceutical Assistance Programs (SPAPs) which may provide you with help paying drug plan premiums and/or other drug costs. Drug copayments covered by these programs will count towards getting out of the donut hole. In addition, Patient Assistance Programs (PAPs) run by many of the major drug manufacturers represent another way to get drugs you need. Unfortunately, none of the expenses covered by PAPs will count toward getting you out of the donut hole. SPAPs and PAPs often only provide assistance to low-income households.
Finally, if you have Medicare and have limited income and resources, you may qualify for Extra Help paying for your prescription drugs. If you qualify, you could pay $3.60 for each generic drug and $8.95 for each brand-name drug. For more information on ways to save money during the donut hole, visit Medicare’s website at www.medicare.gov/part-d/costs/coverage-gap/ways-to-lower-drug-costs.html or call 1-800-MEDICARE (1-800-633-4227; TTY/TDD users should call 1-877-486-2048).