Patient Assistance Program
Patient Assistance Program
There’s no such thing as an amazing Medicare prescription drug plan.
Two main reasons for this are:
- The coverage gap which is also known as the donut hole
- There is not maximum out of pocket limit
No maximum out of pocket limit
Medicare drug plans use stages which include:
- Deductible
- Initial Coverage
- Coverage Gap (Donut hole)
- Catastrophic Coverage
You can read more about how you reach each stage here.
During the Coverage Gap stage, you pay 25% of the cost of a medication. So you pay $100 to fill a $400 prescription. Better than paying $400 but it’s still fairly expensive.
Patient Assistance Programs
Many prescriptions use a patient assistance program.
These programs exist to help people save money to fill the prescriptions they need.
The company that makes that prescription lowers your costs to fill that prescription. It varies by plan but the savings are significant.
Eligibility usually varies based on your income. But these programs are designed by the manufacturer of the prescription. So each company gets to set up there own set of eligibility rules.
I’ve had people apply to two different programs at the same time. He was be eligible for one and not the other. This still helps because he had a $5 copay to fill a prescription that was costing him over $100 each month to fill.
Worth researching?
It’s worth researching if you are paying more than $100 to fill one medication each month. There’s very few patient assistance programs for medications that aren’t considered expensive.
So we likely won’t find many programs for medications that cost you $40 to fill each month.
Where to Research
Contact me and I can try to narrow it down for you.
But if you are a DIYer then here’s a few resources:
Google the name of your medication + patient assistance program
Doctor’s office – many providers have someone that can help complete the paperwork for any programs you are eligible for
Click the link below to set up a time to talk with me about your Medicare insurance