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.

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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.

1-877-386-0206

Chronic Disease Series: ALS (Lou Gehrig’s Disease)

Chronic Disease Series: ALS (Lou Gehrig’s Disease)

blog Medication Assistance

ALS was thrown into the spotlight last year with the massive popularity of the Ice Bucket Challenge. This viral trend was meant to raise awareness, but you might be left wondering just how the disease affects those who suffer from it. Whether you’re currently living with ALS or just looking to learn more about the disease, in this blog, Simplefill outlines some of its basic facts and ways to go about managing symptoms.

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