Ask the Medicare Specialist
QUESTION:
From Patty: In a very recent column you discussed a “Patient Assistance” program that would provide many expensive diabetic medications for free. You also said you could supply the application and assist in its completion. Do I have to buy your Medicare insurance in order to get that help?
ANSWER:
Absolutely not. First, there is no such thing as “our insurance.” The Health Insurance Store is not an insurance company. We’re not limited to selling just one brand of products nor are we beholden to any company. Myself and the other licensed agents are brokers, appointed to provide health and Medicare policies from virtually every competitive provider on the market, ensuring unbiased advice and the best value for each client’s personal health care needs and budget. When I got this question via email, I did chuckle a bit before answering because we always provide advice and consultations at no cost. We’ll provide anyone an application who makes a request and guide them through the process. It’s not necessary to be a current client or change plans.
I understand why people might be skeptical. After all, my column is a solicitation. And in today’s market it’s quite uncommon for any business, especially one that’s for profit, to offer anything for free.
I’ve been in the health and Medicare insurance field going on 13 years now. From day one I’ve seen what a struggle it is for so many seniors to afford their life sustaining medications. I’ve watched brand name drug prices, specifically insulin, increase 400% to 500% in less than 10 years. Newer diabetic treatments such as noninsulin injections have been introduced to the market at a retail of as much as $1,000 for a month’s supply. I’m appalled by these exorbitant costs, especially compared to what they are in other industrialized countries. I’ve been extremely focused on finding ways for seniors to save money since I first discovered what a widespread issue it was. The news we discovered recently of a program that changed policies to help those on some of the most common and expensive diabetic drugs save thousands of dollars a year was one of the biggest developments for seniors since PACENET raised their income limits. These Patient Assistance programs are open to tens of thousands of more seniors than PACENET because the income limits are as much as $30,000 higher! And there’s even more good news since the last column on this topic ran. We’ve found two other programs that are also offering diabetic meds at no cost.
In case you didn’t read two weeks ago or need a refresher, almost all Patient Assistance programs recently had other qualifications besides income for those who are on Medicare and have Part D. First, one had to fall into the dreaded “Doughnut Hole” and then were required to spend from $900 to as much as $2,400 on medications before they would be supplied for free. For some, by that time, the Doughnut Hole spending requirement would be met, and the savings no longer be significant.
But now the last two obstacles have been removed by at least three programs! As long as your income is under 400% of the Federal Poverty level, $51,000 for a single person and $69,000 for a married couple, once your application has been processed, which I’ve been told happens very quickly, the following diabetic medications will be provided at no cost: Insulins Tresiba, Levemir, Novolog, Novolin, and Humalog; Non-Insulin injectables Victoza, Ozempic, and Tresiba; Type 2 oral medications Januvia and Jardiance. That’s a big list and probably 75% or more of the most prescribed brand name diabetic drugs on the market today. Please note the income limits for Jardiance are a bit less at 300% of the Federal Poverty Level.
The timing of this couldn’t be better too as May and June are very common months for people to find themselves in the Doughnut Hole. When that happens, co-pays go from an average of $35 to $45 to $125 to $250. Again, call or email us if you would like a copy any of the applications. And to answer Patty’s question again, we’ll provide regardless if you’re a client or not. You don’t have to change companies. They aren’t cumbersome or difficult to complete either. The hardest part will be getting your prescribing doctor to fill out their portion attesting your medication is medically necessary.
If you didn’t see a brand name drug on the list, or you’re taking one for a medical issue other than diabetes, that doesn’t mean there isn’t a Patient Assistance available. We’re happy to give you the information and qualifications or do the research if we don’t have it at our immediate disposal. It’s uncommon for a medication not to be associated with one of these programs. Visit our website to watch my latest (and first ever) webcast where I go into more detail regarding Patient Assistance Programs, drugs covered, and why medications cost so much more in the US than other countries.
Please keep your column topic questions coming as well as any others you may have regarding anything health or Medicare insurance related. We are still providing services and consultations over the phone or via Zoom meetings and very soon will be resuming face to face appointments with those who are comfortable doing so.