Medicare Donut Hole Effect I would like to take this opportunity to share the effects of Medicare D on someone who has expensive necessary medications. Allow me to tell you my story. I was diagnosed as having bipolar disorder in 1993 and placed on Prozac for depression and a variety of mood stabilizers. I was a model patient compliant with my medications and have not been in a psychiatric facility since 1993 which is just about unheard of. However I fought with severe depression and suicidal thoughts along with hypomania until 2014 when my Mental Health Provider suggested Latuda. At the time I was 64 and working. I had CVS Caremark through Champus insurance and could afford my medication. The next year when I turn 65 my Latuda under Medicare D cost $1550/month! Just because I turned 65! I then purchased my medication from Canada Drugs for $250/ month. You may ask why the difference? The difference is because Medicare does not negotiate prices for a lower price. I received the exact same medication, packaged exactly the same. Recently the US government has forbidden Canada from shipping medication to patients in the US. I was forced to buy from CVS Caremark (the same company as used before) . The cost would be $1500/month.It had been $150/month with different insurance plan. It took 2 years of petitioning Medicare to reduce the drug tier classification so that I could afford Latuda. In the interim I had to take Abilify which had side affects requiring me to take 2 additional medications and experience symptoms of bipolar disorder. When I received drug reclassification I thought yahoo! Once again Medicare fails! I had reached my donut hole and now have to pay $6,000 out of pocket for ALL my medications before any of my medications are paid for. I receive only 25% coverage until then. What I would like for you to know is that when you turn 65 you no long have control over your choice of medications and much of your medical care. I have Plan F which provides good medical care but medications are not negotiated and if you have expensive drugs you are not covered. This is what socialized medicine looks like. If you have any unique problems or costly problems you are penalized. Socialized medicine is for the common masses as inexpensively as possible. Individuals are not seen or heard. I do not qualify for drug company assistance programs because I am on a government subsidized program known as Medicare D. To qualify for Federally Assisted Medicare programs you can own nothing but a car and house and make no more than $14,500/year. I make $25,000/ year! Please be aware of how socialism is creeping into our society. If you could spare a dollar or two to help me keep from falling back into a depressive/hypomanic state due to lack of appropriate medication, I would appreciate it because I really am at a loss.
- Debi McCullers
- Susan Kuhns