The Dreaded Donut Hole and Medicare Part D Prescription Coverage for Plavix
Posted Jul 04 2010 5:37pm
Are you just now getting to the point of signing up for Medicare Part D prescription coverage? Believe me, it is just as confusing as everyone makes it out to be. My grandmother refused to sign up because she could not figure out which plan would actually cover her prescriptions! If you do not already know by now, there are multiple plans in each state and some only cover certain medicines. So, even if you sign up for a specific plan, not all of your medicines may be on that formulary (list of drugs covered). Plus, all the plans have different monthly costs and deductibles.
I found a search tool online that allows you to look for plans in your state based on a particular medication. Given that Plavix is one of the most popular cardiac drugs (and one of the most expensive!), I searched the plan database for prescription coverage of Plavix. You’ll see on the results page that monthly premiums range from $21 to over $100 a month. This monthly cost is in addition to the cost of each prescription per month. For Plavix you may pay an additional $10 to $80 a month for a 30 day supply.
You might be thinking, “Why would anyone pay $100 a month for a drug program when they can pay as little as $21 on another plan?” Good question! The reason that some people might find the $100 a month plan appealing is because that plan offers a $0 deductible and full gap coverage. The $21 plan requires that you pay $310 to start off with and they will not cover you during the dreaded Medicare Part D “donut hole.” During the donut hole, cheaper plans will not pay for any prescriptions once the company has paid for $2,380 worth of medications. You continue to make monthly premium payments but you also must pay for the full cost of each drug as well. The donut hole does eventually end once you have paid $4,550 for your prescriptions out of pocket. However, if you pay for a more expensive plan that covers you during the donut hole you will not need to worry about gaps in coverage at all! It’s a tough decision which is why having a plan comparison tool like this is such a great find! Click on the link below to go straight to the plan finder: