The Medicare Donut Hole Explained

The Medicare Donut Hole Explained

Medication Assistance

What is the Donut Hole?

The coverage gap, commonly called the “Donut Hole” is a temporary limit on what your Medicare Prescription drug plan will pay for your prescription drug costs.

While you are in the “Donut Hole”, you will pay higher costs of for your brand-name drugs. Often times these increased costs make your medications unaffordable.

If this sounds like you or someone you know, call Simplefill Prescription Assistance programs to enroll in their program during this period. 1-877-386-0206

The experts at Simplefill make understanding your Medicare Part D plan…well Simple!

There are 4 stages to your part D plan. Let’s break it down for you.

Stage 1: Deductible Phase
In this stage, you must pay a certain amount out of pocket before your prescription drug plan will kick in. This amount varies by plan.

Stage 2: Initial Coverage Phase
After you hit your deductible, you will start paying the plan’s cost share for covered medications. Once you and your prescription plan have spent $3,310.00 in 2016 for covered drugs; you’ve reached the “Donut Hole”.

Stage 3: The Donut Hole, Coverage Gap Phase
This is the stage where you start getting that sticker shock. Unless you want to wait until January 1st when your plan resets, you will now be paying 50% of the retail price of your medications. This can be very expensive and not an option for most patients, especially ones who are on fixed incomes.
This is why we urge you to contact us at 1-877-386-0206 or apply for assistance online.

Stage 4: Catastrophic Phase
You get a bit of a break in this stage since you have spent so much out of pocket for the year. During the catastrophic stage, you pay whichever amount is greater –either 5% of the covered drug cost or $2.65 for generics and $6.60 for brand name drugs.

What if I am not in the coverage gap but I still cannot afford my medications or my medication is not covered at all?
It never hurts to pick up the phone and ask. Often times we can help patients when their medication is not covered or if they have a copay is unaffordable. We always advise our patients to call us and we can find them the best way to save money on their medications. Think of the team at Simplefill as your Medication Savings Advisors!

My Brother, Fabrice.

My Brother, Fabrice.


A letter from Simplefill’s co-founder, Brigitte Steibel.

On July 30, 1998, my brother Fabrice died from the AIDS virus. He was a fashion designer and artist.
At the age of 25 Fabrice had already started his own design company. Worldwide recognition came in the 1980’s when he was named Essence magazine’s Black Designer of the year, honored with the Coty Award as well as the CFDA. In 1985 the Pittsburgh Ballet Theatre awarded his achievement for creating provocative, seductive and dazzling evening gowns. Fabrice’s creations were featured in fashion magazines, books, record and CD covers, TV shows and movies. The media declared his designs as wearable art!

When Fabrice died The New York Time wrote half a page Obituary honoring his accomplishments.

I was my brother’s caretaker. I would watch my brother take up to 35 pills a day. It was called a cocktail and it did a poor job controlling the progression of the HIV virus. Today the HIV virus can be treated by taking 1 pill a day.

Due to medical research and a much better understanding of the syndrome, many patients who are inflicted with the HIV virus can live a very long and happy life. The FDA recently approved Prezcobix and Genvoya. Both of these are combination drugs that have seen positive results in the treatment of HIV infection. There is still no cure for AIDS, but strict adherence to anti-retroviral regimens (ARVs) can significantly slow the disease’s progress and prevent secondary infections and complications.

This is all fantastic news but there is still a high price to the available medications. Many patients find it unaffordable.

I am dedicated to making sure I do whatever I can to help patients find ways to afford their treatment. Whether that be patient assistance programs or funding through available foundations. It is too late for my brother, Fabrice, to benefit from the new approved drugs, but it’s not too late for you.

Give Simplefill a call if you are having difficulty affording your co-pays. We truly understand what you have been through.


How to Get HIV Medication Cost Assistance

How to Get HIV Medication Cost Assistance

blog HIV Assistance Medication Assistance Prescription Assistance

An estimated 1.1 million Americans live with HIV every day. Proper medical attention is essential in order to cope with this taxing illness, but too often the AIDS and HIV treatment cost hinders patients’ access to this vital care. If you cannot afford the cost of HIV medication, then there is a solution. Simplefill is dedicated to helping individuals who are under- or uninsured, providing that crucial link between patients and Prescription Assistance Programs.

To get support from Simplefill, fill out and submit the short application. A Simplefill Advocate will give you a call within 24 hours of submission to get more details and, if you are eligible, will promptly enroll you in the program. Once you are a Simplefill member, Advocates will help you complete your tailored Prescription Assistance Program applications to provide access to free or low cost medication. No two patients are alike, and by combining our extensive knowledge of the health care system with the individual needs of our members, we are able to get you the affordable medicine you need to live with HIV. We also research alternative funding programs and prescription options to relieve the financial burden of most prescription medicine.

Simplefill members don’t just get access to affordable medicine for AIDS; they also have the peace of mind that their needs are being taken care of by a team of specialists. Our services include personal medication management, so that you don’t have to feel insecure about when your prescription will arrive. We believe that our members should be focusing on their health, so we focus on providing them with reliable access to affordable or free HIV medication.

If you are living with HIV, support is just a phone call away. Reach out to a Simplefill Advocate today at 1.877.386.0206 to get prescription assistance you need.