CINCINNATI, Jan. 22 /PRNewswire-FirstCall/ -- As Medicare Part D enters its second year, Medicare experts have come together to develop a program to help seniors avoid the coverage gap -- the point at which Medicare stops paying for any portion of prescription medications and patients have to pay 100 percent of the medication costs out-of-pocket. In 2006, an estimated four million seniors fell into this gap, and many of them were caught off guard as they simply were not aware that the gap even existed.
"While there is information out there about Medicare Part D, it's not always easy to understand or decipher," said Dr. Timothy Covington, professor and Director of the Managed Care Institute at the McWorter School of Pharmacy at Samford University in Birmingham, Alabama and co-author of the program's materials. "Through this program we wanted to help seniors by giving them simple explanations and concrete examples of how to manage and possibly avoid the coverage gap."
About Medicare Part D and the Coverage Gap
The Medicare Part D program is a voluntary benefit that makes prescription medication coverage available to people with Medicare. The program began in 2006 and has helped millions of seniors gain affordable access to prescriptions. 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, the member arrives at Phase 2, also called the coverage gap. In the coverage gap, Medicare Part D stops paying for any portion of prescription medications. During this phase, members have to pay 100 percent of medication costs out of their own pocket, unless they have a Part D plan that bridges the gap. Once they spend enough to reach a second limit, the catastrophic coverage, or Phase 3, starts. Phase 3 is when Medicare pays nearly all of prescription costs (95 percent).
"In my frequent interactions with seniors, I find that many are seeking help and advice on how to stay out of the coverage gap in 2007," said Dr. Covington. "To help them, I offer the following tips:
* Make sure that you are choosing the right plan for your prescription needs. * Communicate with your insurance company and your pharmacist to make sure you know how much you are spending on prescription medicines. * Talk to your doctor and pharmacist to determine if there are over-the-counter alternatives available to treat your conditions. For example, if you have a condition such as frequent heartburn and regularly use an acid reducer, you can talk with your doctor 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."
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(*) NDC Health, NDC Physician Recommendation Audit (April 2004 - December 2005, Acid Reducer Category). Data on file. (**) Based on share of recommendations: Pharmacy Today 2004 OTC Survey, Acid Reducers. (***) Based on dollar sales. AC Nielsen FD+ dollar share of heartburn (12/28/03 - 5/27/06).
Procter & Gamble
