How to Minimize the Donut Hole

Saving money on Part D or how to minimize the coverage gap aka “donut hole” 2014

  1. If you think you might be eligible for LIS (low income subsidy) “assistance” in paying for your Part D drugs explore this with Social Security (800)772-1213 or Medi-Cal. Apply online at
  2. Take advantage of VA or Tricare benefits if you are eligible
  3. Find out if you can save money using mail order programs through your plan.
  4. Make sure you are using one of your plans “preferred pharmacies”. Shop and compare at different pharmacies, including “big box” stores. If they have a pharmacy, membership in the store is not required.
  5. Many drug manufacturers also offer assistance for people who take some of their expensive drugs. Look at Patient Assistance Programs: Call 800 633 4227 for mfg.
  6. Drugs online or from Canada? What you pay is not credited toward out of pocket max on Part D.
  7. Ask for free samples from your doctor.
  8. Can you alter your dosage or frequency? Works for some drugs, not others. You must consult with your doctor or pharmacist before you consider this.
  9. Are there other drugs similar to the ones you are taking that might be cheaper? Consult with your physician.
  10. Generics? Have you tried a generic and it didn’t work. Ask your pharmacist to try a different manufacturer. Very significant savings over Brand.
  11. When you reach the coverage gap, or so called donut hole, you are responsible for 47.5% of the cost of brand named drugs and 72% of the cost of generic drugs. Make sure your Part D plan actually covers your drugs without restriction.
  12. You can sometimes request an exception if your drug is not covered on your Part D plan. Some plans will also allow you to request a lower rate tier on appeal.
  13. Not enrolling in Part D is penny wise and pound foolish. Penalty for not enrolling is 1% per month that you were eligible. And, you run the risk of needing an expensive prescription with no coverage and no way to enroll until open enrollment.
  14. If you’re over 65 and enrolled in an employer sponsored plan, make sure their Part D coverage is “creditable” or you may incur the 1% per month penalty. Most plans are.
  15. If you’re on a Part D or Medicare Advantage plan and it’s working fine, pay very close attention at renewal to see if any new restrictions are being put on your drugs.
  16. How to shop Part D: Go to . Or, find someone to help you.

If you purchased coverage through an agent ask them for advice. Drug store/pharmacist may be able to shop your drugs and help you find the best plan. Center for Health Care Rights (HICAP): 800 824 0780 or 800 434-0222 Medicare: 800 633-4227

Make sure that you don’t just buy the cheapest monthly premium plan. Make sure all drugs are on the plan “formulary”. Also, check to see if your drugs are subject to any restrictions such as pre-authorization, step therapy or quantity limits (where applicable).

Compiled by Paul Davis CA Insurance License 0669770