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Light at the End of the Medicare Part d Tunnel

Millions of Americans are finding themselves uninsured or underinsured and , therefore, finding it difficult to receive medical treatment they can afford. State Medicaid programs, already over-burdoned, may offer coverage for children for those families that meet financial qualifications. There is a national program called C.H.I.P. – Childlrens’ Health Insurance Program – that is available to all uninsured children and teenagers in each state. The program covers all doctor visits, necessary diagnostic testing, dental care and vision care. Phone numbers for the programs can be found by contacting the state’s Department of Human Resources. For senior citizens and the disabled who are on Medicare, there is no coverage for dental, minimal coverage for eye exams, and copays for each doctor visit and diagnostic test. Each state has a program called S.H.I.P. – Senior Health Insurance Assistance Program – that offers free counseling and assistance to help with care they cannot afford. The phone numbers for S.H.I.P. programs can be obtained through the Department of Human Resources or a local Bureau on Aging.

Those who do not qualify for Medicaid or Medicare can receive medical treatment through free clinics or clinics that operate on a sliding scale. Free clinics do not charge for any medical treatments, including vaccinations and diagnostics. Some offer free dental and vision care. Other clinics offer services based on the individual’s income and charge according to a sliding scale, with the patient paying a very small amount of money for services rendered. Some independent physician practices are also offering treatments on a sliding scale, dependent upon the patient’s income falling under their financial guidelines. Some clinics also offer to prescription medications at extremely reduced rates.

Express care practices are available in many areas where patients are able to see a doctor without being an established patient. These offices are open 7 days per week and are convenient when a patient needs to see a doctor but his or her regular doctor’s office is closed. Express care offices do not offer free services but are an alternative to going to the Emergency Room at a higher cost. Urgent care offices are springing up to take patients who need immediate care and is another alternative to going to the ER.

Many major pharmaceutical companies offer free or low-cost prescription drugs to patients who had no insurance or were underinsured, even to senior citizens prior to the enactment of Medicare Part D. Once Medicare Part D became law, many of those pharmaceutical companies continued to offer patient assistance programs only to those who had no insurance coverage. The patient must complete an application that includes income and a signed physician statement along with a scrip from the doctor. Once approved, the pharmaceutical companies will either ship the prescriptions to the doctor’s office for pick-up, or directly to the patient’s home.

Over the past four years, some drug manufacturers have revised their eligibility requirements, allowing Medicare Part D patients to obtain much-needed prescriptions through the patient assistance programs once they fall into the coverage gap. Patients must fill out an application that includes income, a statement indicating the patient has reached the coverage gap, and a signed statement from their physician. A new scrip from their doctor must accompany the application.

You can go to rxassist.com/org or pparx.org to look up the name of the pharmaceutical company that manufactures your medication. When you submit your entry, you will be brought to a site that lists all medications for which that company offers patient assistance programs. By clicking on your specific medication, you are directed to a page that lists eligibility requirements and a place where you can download and print an application.

Some of the main pharmaceutical companies that offer patient assistance programs to Medicare Part D patients are as follows:

Abbott Labs – will make exceptions for Medicare Part D patients on Humira dependent upon household income and health expenses.

AstraZeneca – accepts Medicare Part D patients who have spent 3% of the annual income on prescription drugs.

Boehringer Ingleheim – makers of Spiriva, accepts Medicare Part D patients who do not have private insurance and have spent 3% of their annual income on prescription drugs.

Merck – may provide assistance after a Medicare Part D patient has been denied and files an appeal.

Pfizer – the makers of Lipitor, Norvasc and Zithromax will provide assistance if the patient is experiencing financial and/or medical hardships. The patient must call a toll free number to apply.

Sanofi-Aventis – those with medical hardships can apply. Applications are reviewed on a case-by-case basis.

Wyeth Labs – Medicare patients can submit an application along with a letter explaining the financial/medical hardship.

Getting medical treatment in a timely manner can mean the difference between prolonged suffering and a speedy recovery. If a person cannot find a free clinic or any other program mentioned here, please contact the local Department of Human Resources. They can offer advice and suggestions, along with phone numbers and addresses for programs available in your area.