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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by HotLobster on July 26, 2006, at 9:58:37
Hi all,
I am on Social Security Disability for my bipolar disorder and depression so that means I am on the new Social Security Drug Plan. I have reached the Doughnut Hole, meaning I now have to pay out of pocket until I have spent roughly $3000 of my own money.
I refilled 5 meds the other day, two brand and 3 generic and the bill was $1400. The main culprits were Adderall XR and Lamicatal. I was unable to pay for my Rx's. I don't quite know what I am going to do. This is the most stable I have been in years and now this. On top of it all I take 15 medications all totaled.
The pharmaceutical companies have stopped their Patient Assistance Programs for those of us who are either 65 and older or disabled.
Has anyone heard or know about monies or programs out there where I might be able to tap into?
My vocational rehabilitation folks can only pay a little bit of my Rx's, it's really not enough to really help. The paperwork is more involved just to get a few hundred buck. But I took the offer in total appreciation!
If anyone should hear of anything that might help my situation please give me a shout!
Just as an aside. This Government Drug Prescription Plan is a nightmare for folks who cannot afford the 3000 bucks. But it just gives you something to look forward to when you reach 65.
Thanks!
Stephen
Posted by Phillipa on July 26, 2006, at 9:58:37
In reply to The New Social Security Drug Plan, posted by HotLobster on July 22, 2006, at 19:50:28
I'm on SSI Disability. But so far have been paying out of pocket for meds . But now I'm on lamictal . I'm still on the starter pack . What does it cost? Thanks Phillipa ps I was given a paper to fill out not long ago for cymbalta from Eli Lilly. Meds were free if you fit the criteria. But I stopped the med. If this is true the government will lose as a lot of people will end up in psych units in the hospitals.
Posted by UgottaHaveHope on July 26, 2006, at 9:58:37
In reply to Re: The New Social Security Drug Plan » HotLobster, posted by Phillipa on July 22, 2006, at 22:13:16
This sounds like a big problem for ppl on the board.
Posted by UgottaHaveHope on July 26, 2006, at 9:58:37
In reply to Can OTHERS give input here? Read 1st post, posted by UgottaHaveHope on July 23, 2006, at 4:24:30
nm
Posted by HotLobster on July 26, 2006, at 9:58:37
In reply to 3k????????????????????????????????????????????????, posted by UgottaHaveHope on July 23, 2006, at 4:24:55
Yup,
The out of pocket cost after you reach the dough nut hole is $3000, of which I do not have. I read an interesting article yesterday stating that those of us with mental challenges take the most cutting edge meds on the market, which means that they are the most expensive! Which, in turn, means that we reach the dough nut whole a hell of a lot faster than other maladies.
Stephen
Posted by Racer on July 26, 2006, at 9:58:38
In reply to The New Social Security Drug Plan, posted by HotLobster on July 22, 2006, at 19:50:28
I've got two suggestions for you:
Even thought the paperwork is a pain in the you know what for the compassion programs from the drug companies, apply anyway. Even if they say they're not covering those on disability, give it a try. All they can do is say no.
Then check out http://www.needymeds.com/ and see what they have to say. Here's a quick answer from their site:
Q: Am I eligible for a patient assistance program if I am on Medicare?
What if I am enrolled in a Part D drug plan?A: The answer is complicated. Last fall, it appeared to be illegal for drug companies to offer patient assistance programs to people on Medicare. That has changed, but some drug companies are still not offering their programs to any patients on Medicare. Another group of companies has made their programs available to Medicare patients who do not enroll in a Part D plan. Some of these companies will help Part D enrollees if their drugs are not covered by their Part D plans. A few companies offer their assistance programs to Part D enrollees who have been turned down for the Part D Subsidy. To get the latest information, contact the PAP which distributes your medicine.
Sounds as though that might be good news for you.
As for the basic problem, though -- that [emulates a Hoover]. No question about it.
So, raise your hand if you think privatizing Social Security is a good idea!
Posted by Jost on July 26, 2006, at 9:58:38
In reply to The New Social Security Drug Plan, posted by HotLobster on July 22, 2006, at 19:50:28
From looking at the ARRP website, which has several informational pages on the drug plan, I would agree with Racer that you shouldn't discount getting relief from the drug companies. (I used the AARP because they would have good information.)
One other thought is that even if the Adderal XR is the best delivery system, you might be able to use a generic amphetamine salt compound that, in smaller doses spread through the day, would be almost as good.
The AARP website discusses how the gap is to be covered by you:
"Q. What counts toward the $3,600 limit?
A. Your deductible; your copays in the initial coverage period; payments for drugs that you have made out of pocket in the gap, whether purchased from your plan or elsewhere within the United States; payments for your drugs in the gap made by a family member, friend, a charitable group or a state pharmacy assistance program.
In all cases, only payments for prescription drugs your plan covers (including any formulary exceptions you receive) count toward the limit."
I guess you've probably calculated all that, but just in case:
1. did you count whatever deductible you've already had before drug benefits started?
2. have you counted all co-pays you made yourself over the year?These two amounts would be an amount by which you would reduce any further out-of-pocket costs that you need to make to reach the top of the doughnut.
The AARP has this following other suggestions..
From AARP:
"Q. I have high drug costs but can't afford to spend $3,600 out of pocket. What can I do?
A. You can try using lower-cost drugs, as explained above, to stretch your initial coverage and lower your expenses in the gap.
If your income is limited, you may qualify for Extra Help. Call Social Security at (800) 772-1213 or go to its website. Or contact a state pharmacy assistance program—call (800) 677-1116 for the number of your state health insurance counseling program or go to shiptalk.org.
Some drug manufacturers still offer free or low-cost drugs to qualified Medicare beneficiaries. Call the Partnership for Prescription Assistance at (888) 477-2669 or visit pparx.org. Or try asking your doctor for free samples."
(Suggestion A would be something to consider next year.)
I hope something here helps.Jost
Posted by Jost on July 26, 2006, at 9:58:38
In reply to The New Social Security Drug Plan, posted by HotLobster on July 22, 2006, at 19:50:28
Also, the AARP website page that discusses this at length is the following:
http://www.aarp.org/bulletin/medicare/bulletin__more_on__part_d_sidebar.html
Jost
Posted by Tymoney on July 26, 2006, at 9:58:38
In reply to Re: The New Social Security Drug Plan » HotLobster, posted by Phillipa on July 22, 2006, at 22:13:16
Has anyone tried for medicaid as well,even if likly the case you are turned down for FULL social security,you can recieve partial,and what that entitles you to is certain benifits,and one of those benifits is,NO GAP,what this means is the limit on the med coverage goes out the window,good bye gone.
All you tell them is you have the extra help,and they shut right up.Again you will likly be turne down for the medicaid and given a SPENDDOWN which is impossable to meet,but you will most likly get some benifits,one being the premium on the meds on ur monthly medicare check,covered,second,the limit on the drug coverage,covered,you just obviously wont have the normal medicaid proviliages but hey the premium covered is great dont you think.
I advise people to contact there social worker imediatly and speak to them on this.
Posted by HotLobster on July 26, 2006, at 9:59:12
In reply to Re: The New Social Security Drug Plan, posted by Tymoney on July 23, 2006, at 22:21:25
Hi,
That is an interesting idea! I am just scared what would be included and what would not, in terms of benefits.
I would love somehow to get a private insurance plan, but as it goes with most big insurance companies; if you qualify for SS and it's no dice with a private plan for you.
With more and more of the disabled and Seniors hitting the doughnut hole, I hope to God that there will be some type of uprising. It's still a while before the elections and that means more time for folks, like me, to hit the doughnut hole and decided it time for some action.
I've been exploring some of the left blogs out there and are reintegrating the same thing I am. So, as you can see, there is still hope.
Thanks to everyone who has exchanged thoughts with me on this subject.
Stephen
Posted by Tymoney on July 26, 2006, at 9:59:12
In reply to Re: The New Social Security Drug Plan, posted by HotLobster on July 24, 2006, at 5:41:31
I forgot to mention to mention,the name is actualy called SLMB.What it is ,is this exacly.
For those who already obtained Disability,you have limitations,which follows....
Normal monthly Premiuims,killing the already small check......
You have a limitation to medication,mostly 2500-3000 average,then ur done,this is reached pretty fast with new meds being as high priced as they are,and diferent trials.You have a premium on the medcation service.
So what Slmb is,well what you would do is apply for MEDICAID,likly as i said you wont get it,theyll give u a notice saying u dont make it,and u have to meet a spend down,which is complicated,in a nutshell u have to note everyt single thing and reach a total they list,which is totaly unreachable for most.However,aside from the full medicaid,there is a very very good chance you will be eligable gor SLMB,what this is,is partial medicaid,and as i said what it entitles you to is,both premiums or all premiums covered,both the normal one,and the new one for the med plan,so u get ur full check.
Second the limitation on he drugs.......GONE GONE GONE.I swear this is true,they call it EXTRA HELP the plad d programs,they hear that and say oh ok.I promise you it works like this.Please is u have disabilit already,and are oosing part of ur check to the premium monthly,if u are watching in fear of reaching the drug limit,contact ur worker and ask about SLMB,it is a saviour,if its not avvailble for some reason in a area i am sorry for giving false hope,but its very easy to not know ur options as case workers sometimes do not jump at the chance to make u aware of all the ways u can benifit,please call and ask,id like to hear some feed back on this if possable,thank you.
Posted by crazy777girl on July 26, 2006, at 9:59:12
In reply to Re: The New Social Security Drug Plan, posted by Tymoney on July 24, 2006, at 13:33:19
also on SSDI.
when I hit my doughnut hole - this is what my monthly Rx cost will be; $3,018.21, some of that is already generic. I will be looking to Canadian pharmacies, as I know there is no help available for me. On paper, I look like I might actually be able to stay above poverty level. Until you consider the actual costs of drugs & medical treatment required to manage a catastrophic illness. I'm at my wits end, as well. None of the programs are for people like me. I guess they are for if I stopped taking my meds, totally lost the ability to function, wound up in a paper box on the street, and lived off of the government. Maybe then I could qualify for prescription assistance of some sort. This is all very new to me. I come from a corporate world of private insurance where everything is paid for & nothing is ever a concern. Now I have to think about whether I can afford to actually be med compliant, or stockpile the ones I know I can't live without.
A.
> I forgot to mention to mention,the name is actualy called SLMB.What it is ,is this exacly.
>
> For those who already obtained Disability,you have limitations,which follows....
>
> Normal monthly Premiuims,killing the already small check......
>
>
> You have a limitation to medication,mostly 2500-3000 average,then ur done,this is reached pretty fast with new meds being as high priced as they are,and diferent trials.
>
> You have a premium on the medcation service.
>
>
> So what Slmb is,well what you would do is apply for MEDICAID,likly as i said you wont get it,theyll give u a notice saying u dont make it,and u have to meet a spend down,which is complicated,in a nutshell u have to note everyt single thing and reach a total they list,which is totaly unreachable for most.
>
> However,aside from the full medicaid,there is a very very good chance you will be eligable gor SLMB,what this is,is partial medicaid,and as i said what it entitles you to is,both premiums or all premiums covered,both the normal one,and the new one for the med plan,so u get ur full check.
>
>
> Second the limitation on he drugs.......GONE GONE GONE.I swear this is true,they call it EXTRA HELP the plad d programs,they hear that and say oh ok.
>
> I promise you it works like this.Please is u have disabilit already,and are oosing part of ur check to the premium monthly,if u are watching in fear of reaching the drug limit,contact ur worker and ask about SLMB,it is a saviour,if its not avvailble for some reason in a area i am sorry for giving false hope,but its very easy to not know ur options as case workers sometimes do not jump at the chance to make u aware of all the ways u can benifit,please call and ask,id like to hear some feed back on this if possable,thank you.
Posted by HotLobster on July 26, 2006, at 9:59:12
In reply to Re: The New Social Security Drug Plan, posted by Tymoney on July 24, 2006, at 13:33:19
Thank you that was very good information. But, as usual, I bring in too much money from SS to qualify. But a big thanks for writing!
Stephen
Posted by Snoozin on July 26, 2006, at 12:24:35
In reply to The New Social Security Drug Plan, posted by HotLobster on July 22, 2006, at 19:50:28
HotLobster,
Many states have wraparound pharmacy assistance plans for individuals with lower incomes, to assist with premiums, deductibles, and that awful doughnut hole on the Medicare Part D prescription drug plan.
Here is a list state-by-state. Don't know how up-to-date it is. I work in Maryland, which has an excellent one.
Good luck!
Posted by Kath on July 28, 2006, at 20:17:16
In reply to The New Social Security Drug Plan, posted by HotLobster on July 22, 2006, at 19:50:28
>> The pharmaceutical companies have stopped their Patient Assistance Programs for those of us who are either 65 and older or disabled.
Whyyyyyyyyyyyyyy?
Do they say why? That's so INSANE. Does it mean that old/disabled people don't count? don't matter?!!!!!! Oh My God.
Kath
This is the end of the thread.
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