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Your money: staying out of the donut hole


Most Medicare prescription drug plans have a coverage gap, often called “the donut hole.”

The donut hole refers to a temporary limit on what your plan will cover for drugs, meaning you pay a larger portion of your drug costs during this period. In 2014, once you have spent $2,850 (including your deductible and co-pay) on covered drugs, you fall into the donut hole. Once there, you will be responsible for 47.5 percent of the cost of your brand-name prescriptions and 72 percent of your generic prescriptions. While not everyone will reach the donut hole, it commonly affects people with chronic diseases such as diabetes, Alzheimer’s, osteoporosis and more.

Talk to a pharmacist before your trip to the doctor

At Community First Pharmacy, our pharmacists are geriatric specialists and are extremely knowledgeable about the prescription needs of older adults. Speaking with a pharmacist before your trip to the doctor could benefit you financially — they can recommend asking your doctor about certain prescription drugs for your specific needs that are just as effective and more affordable. In addition, they can take the time to discuss your current health and may find medications that you may no longer need to take. Spending less on your prescriptions keeps you out of the donut hole longer.

Consider the drug’s generic version

Throughout 2014, several of the world’s best-selling brand-name drugs will lose their patent, allowing generic versions to be sold at a much more affordable cost. Generic versions of top-selling drugs for high cholesterol, high blood pressure, osteoporosis, chronic kidney disease, breast cancer and more are all set to become available in 2014.

Expiring patents include: Trilipix, Micardis, Actonel, Renegel, Nexium, Evista, Celebrex, Detrol LA and Lunesta among others. Generic versions contain the same active ingredients and are chemically equivalent to the brand-name drugs, but they typically cost 20 to 80 percent less.

Ask for the cash price

Especially with generic prescriptions, paying with cash could be cheaper than using your Medicare coverage. For example, you may have a co-pay of $12, but be able to get a three-month supply of certain drugs for $10 if you pay in cash. In paying with cash, you are not using your Medicare coverage, and therefore not contributing to the $2,850 current spending limit before falling into the donut hole.

Stick with one pharmacist

Compare the costs of all your medications as a whole and choose the pharmacy where you get the best overall price. By getting all your medications from the same place, you are reducing the risk of harmful drug interactions and forming a relationship with your pharmacist, so they are better able to understand your health needs.

The nonprofit difference

Being a nonprofit pharmacy allows Community First Pharmacy to provide several cost-saving measures such as reduced markup on prescriptions for clients. Our pharmacists are geriatric specialists and have a greater understanding of the changing needs of individuals as they age. We take the time to discuss medication concerns, and we work with physicians to find cost effective alternatives to ensure the best pharmaceutical solution that meets both health and budget needs.

If you have questions about your prescriptions or the changes to healthcare and pharmaceuticals, stop in at Community First Pharmacy at 210 S. Second St. in Hamilton or call 513-645-5447.


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