Coverage gap or "doughnut hole"

[jaysunb]

After nearly 6 years of SS and Medicare, I was informed that my many medications would now cost triple the regular amount for the next 3 months.
Now, I've always been aware of this phenomenon, but never thought it would affect me as my meds have not changed much over the years ---that is, until I started using the latest diabetes drug, Invokana. Initially they wouldn't pay at all, costing me $350 per month. After about 6 months and some request by my primary caregiver, they relented and gave it to me for $95.00. Great ! Then in January of this year, it suddenly cost only $45.00. OH JOY !

Well, I'm really not sure what happened but 9 months into the year I'm in a hole. ( I like doughnuts, and this aint it) I'm wondering if anyone else has seen a collapse in coverage this quickly or if there was some sort of increase that I missed ???

[tg]

1. Yes

Victoza, another diabetes drug. The first full year I went into the donut hole and out the other side into catastrophic coverage.

[HeiressofBickworth]

2. Just ran across your post.

Before I went on Medicare, I used their on-line calculator -- adding the meds I take which gave me the approximate time I would hit the doughnut hole. Initially, it was MAY!!! Crap, that simply can't happen. So I sat down with my Dr. to go over everything -- converted all that I could to generics, some of which would only be $4 if I paid out of pocket. There were a couple that were on the high end expensive so I was better off using my RX plan to pay for them.

It took a lot of work, figuring med prices, where to get them (never in a million years would I go to Walmart). In the 5 years I've done this, I hit the hole only once. Reevaluated the meds, made another change, and for the past three years, I haven't hit the hole.

With drug prices generally going up, I'll probably have to run the figures again to be sure I stay out of the hole. Paying for generics out of pocket is less expensive than having to pay about $500 a month for just one of the drugs I take if I hit the doughnut hole.

I'm also not shy about asking my Dr. if there is a generic equivalent or if a less expensive drug would do the same job. I avoid "new" meds anyway, not only because they are so much more expensive, but too often they find out that they rot your insides or have horrible side effects. I'd rather take something that has been on the market for five years or more so there is a track record.

[LibinMo]

3. Have you looked into GoodRx.com?

My husband takes a lot of prescription drugs and we've been able to stay out
of the doughnut hole by buying cheap generics and paying out of pocket.
I use one drug store for all the insurance covered drugs and then find the cheapest generics using Goodrx.

The last insurer we used was charging only $4 for generics to us but claiming the drug cost them $20-$30 and adding that to the total cost. That would have put us in the doughnut hole. Same drug from KMart was $4 period. It's a shell game.

Anyhow, GoodRx can find some really great prices. You can go online or download their app for your phone.