Everyone knows that donuts are not health food. They may taste good, but they’re mostly empty calories–sugar, fat and white flour. Only the hole is non-fattening.

Millions of senior citizens are now sampling a different kind of donut hole. This donut has no flavor, but the main side effect is an empty wallet.

Medicare Part D provides prescription drug coverage, up to a point. This year, once a recipient’s total drug bill tops $2,700, Medicare stops picking up any part of the tab until the total hits $6,154. In that so-called donut hole, every penny for prescription drugs rung up at the pharmacy comes out of the customer’s own pocket. This can pose a real hardship for anyone on a fixed income.

This is the time of year that many seniors begin to experience the sticker shock of the donut hole. They discover how much their medicine actually costs. Up to that point they were paying no more than 25 percent.

Take a hypothetical example, Mr. Sanchez. He is 68 and takes Advair for asthma, Actos for diabetes, Nexium for acid reflux and Flomax for prostate enlargement. A few months ago his monthly bill was steep but almost affordable at around $180 per month. Once he got into the donut hole, however, he had to fork over more than $700 each month.

Mr. Sanchez is taking pricey prescriptions, but he is not unique. The pharmaceutical industry has been raising prices on some of the most popular medicines, perhaps in anticipation of a health care reform bill. This makes it difficult for a lot of people to afford their medicines.
Those with really expensive medications may emerge from the Medicare donut hole. Once the total drug bill for this year tops $6,154, the government picks up 95 percent of the tab.

In the meantime, some patients are having trouble taking needed medicines as the doctor prescribed. They’ve cut back or failed to fill prescriptions.

In a case described in The New York Times, a heart attack survivor could not afford to fill a prescription for Plavix, a medicine that prevents blood clots. The co-pay was unaffordable at $160. He suffered a third heart attack a few months later.

Some patients wonder if Canada is the answer: “How reliable are drugs from Canada? My husband has Alzheimer’s disease and diabetes and takes many drugs. We are in the donut hole and I am considering mail-order drugs. Good idea or big mistake?”

The answer depends on the shopper’s vigilance. Not all online pharmacies are reliable. Some that claim to be Canadian are not. Drugs bought from international online pharmacies (Canadian or other) do not count towards getting out of the donut hole.

But for those who don’t anticipate getting through the donut hole this year, buying from a legitimate Canadian pharmacy may be an option. We have prepared a new Guide to Saving Money on Medicine that describes how to evaluate online pharmacies, offers tips on finding free medicine and tells how to use generic drugs wisely. 

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  1. Lloyd C

    Whether Medicare or not, I wonder how much we spend unnecessarily because we choose (and our doctors choose) newer drugs when older/cheaper ones would work and be more cost effective.
    I’m in my mid 40’s and over-weight. At 6’0, this time last year I was 330 pounds. With minor changes to diet and walking more I’m down to 280 and aiming for 220 by year end of 2010.
    A couple of years ago I left a corporate job to start my own consulting business and when my COBRA coverage expired I could only buy a catastrophic coverage insurance plan with a prescription drug plan that is more costly than paying full price at Wal-Mart.
    One of my drugs, Actos, ran about $7.50/pill or $225/month. I never thought about it when I had the old insurance because of a very low co-pay. When I had to pay the full cost I was surprised. At my next doctor’s appointment I asked about a lower cost alternative. He said there was one he’d try, an older drug in the same class, and if that didn’t work he’d go to taking insulin (I’d rather pay the full cost of Actos).
    The replacement drug (Glimepiride) is working fine and is on Wal-Mart’s $8/month list. Later I asked about replacing Lescol XL (at about $4/pill) and replaced it with Simvastin ($24.36/month). Across the spectrum of what I am taking, my costs per month are now less than one-tenth of what it was before I started asking my doctor about lower cost alternatives and my health is better.
    So when I hear about people complaining about their costs of pharmaceuticals, I really wonder if they’ve talked with their doctors about more cost-effective alternatives. I wonder too what it would take to get more doctors to think about using the older, cheaper drugs before trying newer ones.
    I have no problem with the pharma companies trying to recoup their investments in their drugs. I also realize that many people need the newer drugs. I just wonder how often the newer drugs are poorer choices for the consumer.

  2. KB

    The Pharmacutical Companies do have programs that people easily qualify for. They have programs that are made for patients who enter the doughnut hole and have Medicare Part D prescription coverage or patients who have health insurance and no prescription insurance. Check out GSKaccess.com, Togetheraccess.com, Needymeds.com I could not understand many of the requirements (I have been told not to even take them seriously) and so I just called the number to speak to a representative. It took very little time and I was told that I qualify. They pick up the cost of all my medications. Everyone should at least call, what do you have to lose???

  3. STEVE W

    I have been in the donut hole for several months already. I use a sleep disorder medicine that costs a lot, and use Plavix. Just those two do me in. I have started to get generic plavix through a Canadian pharmacy. It actually comes from India; from the little research I did on the internet it seems that the company in India is a well known large company for whatever confidence that gives.
    I hope it is quality, but I am nervous about it. I takes about 2 to three weeks shipping time. Each tablet comes in a sealed foil package. My current cost was $90.00 for 90 pills. If you do not see me replying to Peoples Pharmacy from time to time then it might mean that it was not quality and I am no longer in this world. If you want to know what the internet address is for the company I use, i would be happy to give it to Peoples Pharmacy if you so allow that.

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