Medicare Part D, donut hole. What's being done. HELP! In the State of California

[just_joe]

I've been a Medicare/Medical recipient since 94. Three years ago when I was forced into the Medicare Part D program I was skeptical. The plan has been changing each year. This year because of the increase in cost of living I receive $1542.00 a month which just takes me out of the bracket to qualify for extra help from Medicare because I am no longer considered low income. With Medical my share of cost per month is $900.00. I'm now told that because of all this any drugs that I'm on that are not covered by ADAP my co-pay is 20% for what the drug cost. Ex: Allegra, which I've been on for years now will cost me $240.00 a month, Oxandrin is $45.00 a month, Serostim is $1200.00 dollars a month. The pharmacy can't even tell me if this will change when I've reached catastrophic coverage because they have raised that amount. Everything changes year to year. Who do write? Is there a program in California to help? What's being done. This is all so ridiculous. Can anyone please help or tell me what to do or where to go to get some assistance with this.   

[Miss Philicia]

Isn't serostim an HGH drug and oxandrin a steroid?  I know for the latter if you have the injection done in a physician's office, instead of taking the pill oxandrin, it would be covered by Medicare. 

But yes, once Medicare Pt. D pays for something, if the med is not on your state ADAP formulary (obviously this varies from state to state) you will be left picking up the remainder.  You may wish to look into alternatives that are on your formulary for now, and inquire with whatever entity took these items off your formulary, as it sounds like from what you are saying that they were at one time on there, but as of 12/31/07 something changed on that list.

I do recall reading recently about the Governator doing something with the ADAP stuff in your state.  Have you contacted your case manager at your local ASO, assuming you have one?  I can't imagine that you're the lone person dealing with this in all of San Diego.

[just_joe]

That's why I posted this because when I go to the pharmacy they tell me that they don't have that many cases that are like mine. Who lives on 1500.00 a month and if there drugs are not covered under the ADAP formulary... HOW? I've tried several times to go back to work and the stress of the jobs only knock my health back down and I end up getting sick and having to quit. It's like I'm being punished for working in my lifetime and for paying into the system. In my eyes 1500.00 a month is low income when you take out the day to day costs of living. Just the basics like rent and food alone. Are we suppose to live in a car and eat peanut butter and jelly sandwiches? I just don't get it. We put these people that are educated into office and they come up with this hair brained Medicare Part D and it's like they really didn't think it through and they put insurance companies in charge who only look at the bottom line. So, now the only people that get things at no cost are those on welfare that have never paid a dime into the system. I bet if they had to live it or one of their loved ones were living it, things would be different.

[Miss Philicia]

I still think you should contact your ASO/case manager and don't just go by what a pharmacy is telling you to be the final word.  Your call though, not mine.

[just_joe]

I will thank you.

[ARMANDO]

do you recieve social security only?do you not qualify for disability?

[BT65]

I think Joe is talking about SSDI.  People who are receiving SSI only are receiving that because they don't qualify for having ample work history credits for SSDI. 

I agree Joe, your income is definitely low.  I will tell you that I get $783 on SSDI; and in the state of Indiana, that only qualifies me for $10/month in food stamps.  Yes, the idiots (Bush) who dreamed up Medicare Part D certainly left a lot of people screwed.  This year I have high co-pays that I didn't have last year.  And because I get Medicaid, I'm not covered by ADAP.  However, the Medicaid will not pick up the co-pays.  My ASO has been covering them the past couple months. 

I agree with Philly about contacting your ASO.  Pharmacies make mistakes all the time, especially about the 'new rules.'  ASO's have more concrete knowledge.  I certainly would not try to go it alone; but that's me.