What if I can’t afford the cost of my drugs in the gap?
First ask your doctor whether any other drugs on your plan’s formulary would be just as effective for your medical condition. Using lower-cost medications, such as generics or similar but older brand-name drugs, will substantially reduce your costs at any time, not just in the gap.
If you don’t have additional insurance (for example, from an employer plan, a state pharmacy assistance program or Extra Help) that pays some or all of your costs in the gap, you may consider other (non-insurance) sources of help. These include:
- Free or low cost drugs from assistance programs run by pharmaceutical manufacturers.
- Free or low-cost drugs supplied by local medical clinics, charities or patients’ organizations.
- Lower-cost drugs from Canada or other countries.
Must I continue to pay my monthly premiums during the gap?
If you stop paying premiums, your plan will likely terminate your contract, leaving you without drug coverage. In that case, if you join a Part D plan again in the future, you’d have to pay a late penalty according to the number of months you were without coverage.
How will I know where I am in relation to the gap?
The monthly statement you receive from your plan must explain how near you are to entering the coverage gap or, if you’re already in it, how much more you need to spend on your drugs this year before qualifying for catastrophic coverage.
If you use the Prescription Drug Plan Finder tool to choose a drug plan — by entering the names of the meds you take, plus their dosages and how often you take them — you can see a bar chart that indicates your total out-of-pocket expenses month by month over the whole year for each plan. The chart shows if and when you’ll fall into the doughnut hole and, if so, how long you’ll stay in it.
Patricia Barry is a senior editor at the AARP Bulletin.
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