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I have Lupus, Fibromyalgia, osteopenia, Diabetes.
Answer Summary
Members helped someone understand Medicare Part D's confusing 'donut hole,' which occurs when prescription costs exceed the plan's coverage... Read more
Sounds like you have medicare. Look at the extra help for Medicare. You have to have limited resources not including your house or car. If you are approved it limits the cost of your prescriptions and you jump over the donut hole. I am on it and usually in june i go to catastrophic coverage and don't pay for prescriptions. All my diabetic meds are the expensive ones trujeo, trulicity and farxiga. Of course i don't know if you qualify but it doesn't hurt to try.
Hi @A DiabetesTeam Member, and @A DiabetesTeam Member, and @A DiabetesTeam Member, and all you warriors.
The way the medicare supplement Part D, aka prescription medication plan, donut hole works is:
Once you reach the limit of the cost plan you bought, you pay out of pocket. Part D insurance can cost as little as $7.00 a month or well over $100.00 a month depending on cost limits. You have to choose the cost effective plan for you. Not easy.
I currently have all generics, so my broker helped me choose a part D that has nominal out of pocket for my medications.
When I decide to go on diabetes medications, I will change my plan to cover them with my fiduciary medical insurance broker.
Some people don't choose to carry a separate Part D supplement. They instead opt for a Part C medicare advantage plan. If they have any chronic illness they are screwed financially until the next year.
Lower the costs of your prescription medications by choosing a Part D plan with a formulary that includes your medications. But that will have to wait till next years open enrollment period.
You could ask your doctors to prescribe lower cost diabetes medications. Older diabetes medications are much less expensive since they are available as generics.
If you go on insulins, the medicare out of pocket is limited to a reasonable cost.
A silver lining is if on insulin medicare says you qualify for a cgm.
Shop around to see if you can find a pharmacy that offers your medications at a lower cost.
Ask the manufacturers for help.
Those are your choices
In the USA our insurance ,Medicare, only allows so much to cover meds. My meds are free to me if they are generic. Brand named drugs comes with high costs. The newest meds for diabetes Mounjaro is covered, but after I filled the first prescription I was told the next refill would put me in the donut hole the rest of the year. This means I would have to pay out of pocket. I hope this explains it better. I try and do portion control with food.
Even though my prescription is for two months at a time my surgery will only authorise two sensors- one month supply each time- meaning I have to phone the pharmacy every month.
It still boggles my mind
A few days back I went over to the pharmacy to pick up my Libre2 sensors - get them 6 at a time (3 months worth) and the come out to $632 (ok Canadian bucks but 1 dollar is still a dollar in Canada) 😁
They hand them over, scan the prescription print out and ask if I want a bag
A day later I get an Email telling me that my Insurance paid the Pharmacy directly and if this doesn't sound correct or fraudulent to give them a call
And this is for CGM sensors for a Type 2 Diabetic that takes "no meds"
That is the way it should be when companies can spend $7 Million USD for a 30 second commercial spot during the Superbowl to "sell you diabetic drugs"
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