Starting in 2011, the INFAMOUS DONUT HOLE can be partially filled in by others … no matter the income level of the patient. The donut hole itself is ~ 3600.00… and how/when the patient gets their Rxs filled… could mean the difference between the patient paying 92% or 50% of that figure out of their own pocket. In the donut hole, 8% of the cost of the generic medications are paid for by the Pharma’s… whereas 50% of the cost of brand names are paid for by the Pharma’s.
If you encourage patient to go on auto fill…. their Rxs are filled as they come due.. which may or may not be of financial benefit to the patient. If the patient normally exits the donut hole before the year is out.. they can save a chunk of money on their Part D medications.. if they pay attention to their EMOB’s and when, if they are approaching going into the donut hole.
The solution is pretty simple, once the person is in the donut hole… try and time the refills of their brand name drugs and get a 90 days supply of those drugs. They will get a $1 credit for all brand names filled in the donut hole and that credit goes towards the person meeting the costs of the donut hole. If a person has 2-3 brand name drugs.. it is not hard to see filling these for a 90 days supply would push them out the other side of the donut hole.. where all their Rxs for the balance of the year will be for a 5% co-pay.
Given the credit provided, it may make financial sense to put the cost of these brand name drugs on a credit card – if necessary – and paying the finance charge for a few months keeping a balance to get them paid off.
This may apply to only 10%-20% of your Part D patients… but.. how grateful are they going to be.. if you are able to cut up to $1800.00 off their annual drug bill? That’s what ??? SEVENTY TWO – $25.00 gift cards.. and they don’t have to transfer their Rxs anywhere nor “pitch one” !
Filed under: General Problems
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