Managing Money on Medicare Part D

(ARA) - The more you know about prescription coverage, the more money you can save. Pharmacist Dr. Timothy Covington, an expert on Medicare Part D, answers your common Medicare questions below.

Dear Dr. Covington: I just turned 65 and became eligible for Medicare. What is the Part D plan that I’ve been reading about?

- Medicare Newbie

Dear Newbie: Welcome to Medicare! The Medicare Part D program is a voluntary benefit that makes prescription medication coverage available to Medicare members. The program has helped millions of seniors gain affordable access to prescriptions.

Dear Dr. Covington: I’ve heard about a phase in Medicare Part D called the coverage gap but I’m confused by it. Please help!!

- Confused by the Gap

Dear Confused: You are not alone. Many members are confused and surprised to learn that Medicare Part D works in three phases. In Phase 1, each member typically pays a deductible and, once that is met, pays an average co-pay of 25 percent for prescriptions. The plan pays the remaining balance. But, if expenses reach an initial coverage limit before the end of the year, you arrive at Phase 2, also called the coverage gap. In the coverage gap, Medicare Part D stops paying for any portion of your prescription medications. During this phase, you have to pay 100 percent of your medication costs out of your own pocket, unless you have a plan that bridges the gap. Once you spend enough to reach a second limit, the catastrophic coverage, or Phase 3, starts. Phase 3 is when Medicare pays nearly all of your prescription costs (95 percent).

Dear Dr. Covington: This year, many of my friends hit the coverage gap and had to spend thousands of dollars for their prescription medications. How does someone fall into the gap and how can this be avoided?

-Avoiding the Gap

Dear Avoiding: Falling into the gap is a problem that some 4 million seniors were expected to deal with in 2006. First you have to understand the coverage gap to avoid it. Many seniors do not realize that three things contribute to the total cost of their prescriptions and count toward the gap: their deductible, their co-payments and the Medicare Part D plan contributions. In 2007, when your total Medicare prescription medication costs equal $2,400, you will pay 100 percent of these costs – until you reach the catastrophic coverage phase, usually at $3,850 out-of-pocket, or arrive at the end of the year. Each January, you start a new coverage cycle.

Patients on multiple prescriptions, or as few as 2 to 3 a day, are in danger of quickly falling into the coverage gap. You can delay or avoid the gap by managing your medication spending and making wise choices. One strategy is to substitute over-the-counter (OTC) alternatives for prescription medications when possible.

For example, if you have a condition such as frequent heartburn and regularly use an acid reducer, you can talk with your physician and pharmacist about using an OTC such as Prilosec OTC. This may be a money-saving treatment option. OTCs do not count toward reaching the initial coverage limit; therefore using these medications can help keep costs down.

Dear Dr. Covington: My pharmacist told me that OTC medications can be as effective as prescription medications. Is this true?

- Looking for options

Dear Options: Yes, they can be. In fact, many OTC medications are former prescription medications, some of which have been approved for OTC status at a former prescription strength. That is the case with Prilosec OTC, and that’s why it is recommended as an over-the-counter option for frequent heartburn sufferers and is the number one doctor and pharmacist recommended OTC acid reducer.

By purchasing medications in a smart way, you can save Medicare Part D coverage dollars to go toward more expensive prescription medications for which there are no OTC alternatives. Consult your health care professional for more information on Medicare Part D and OTC medications to determine the best strategy for you.

Dr. Timothy Covington is a professor and Director of the Managed Care Institute at the McWorter School of Pharmacy at Samford University.

For more information on the Medicare Part D coverage gap, please visit www.ManagePartD.com. For full patient information on Prilosec OTC, log on to www.prilosecOTC.com.

Courtesy of ARA Content