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PennySavior

Didn't see the SSA Extra Help program listed: https://www.ssa.gov/benefits/medicare/prescriptionhelp/ Never give up hope!


dee62383

I just spoke with her. She said she's already enrolled in that program, and it hardly helps with anything. :'(


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Bamagirl31088

I’m on tier 4 of extra help.


yeahlance

Have you tried either a) looking at a different plan to see if the partial extra help - helps better on a different plan or b) asking your plan for a tier reduction on your medication? Some plans are lenient with the tier reductions, and others are flat out unhelpful, but obviously worth a try! Also, partial extra help is typically given when your assets are over 7860, so if assets may have went under that, it could also be worthwhile to reapply and see if they give you full extra help instead of partial.


Bamagirl31088

I’m just make the cut off to get extra help. Literally one more penny and I’m booted off


colorofmydreams

Have you told your doctor about your situation? I take a very expensive inhaler and my doctor gives me samples. Even if you still have to buy it sometimes, getting some samples will cut the average cost of the prescription. That's the only thing I can think of that you haven't already tried, other than applying to charities or something.


Bamagirl31088

I have. They have me a 7-day sample pack. Bc of COVID their drug reps aren’t coming by as often and they’re limited on how many samples they leave with them.


Aware1211

I'm in that and my total cost for most meds is $3.60. She should get into an HMO with meds plan. Costs are lower. EDIT: Also look into her State's Medicaid program. There are charities for specific illnesses which will pick up a patient's share of cost. Good luck.


dee62383

A lot of people are suggesting Medicaid. If that's an option for her, I will encourage her to pursue it.


YawIar

I’m a pharmacist and this is a very common issue. If she reaches out directly to the manufacturer by calling the number provided on their website, she will most likely be able to get help directly from them (even if she doesn’t qualify for their copay card due to having Medicare). I’ve had at least 3 or 4 people who I’ve helped to accomplish this and all of them told me that the manufacturer was extremely helpful and easy to work with, and all of them ended up paying nothing for the medication, even for the long term.


aviatrixsb

Agreed! Sometimes they have an assistance foundation that might deny the first application if you already have insurance, but you should appeal on the grounds that even with insurance the cost is too high.


dee62383

I'll let her know. Thanks. 👍🏻


fitsaccount

Just to set expectations, this *may* not work long term. I'm not familiar with OPs medication but insulin manufacturers cap this benefit at a few month's worth of drugs.


dee62383

She called, and they said she won't qualify due to her having Medicare.


YawIar

I wonder if she just doesn’t meet their income requirements then because I’ve had multiple Medicare patients who were able to get it through the manufacturer by speaking directly to a representative regarding financial hardship.


dee62383

That's a plausible theory.


Admirable_Nothing

The alternate medication only requires a blood test once a month. Been there and did that.


Bamagirl31088

As have I...I’m the person Dee is tryin to help. I’m that messed up, everytime im on Coumadin I’m so up and down and we could never regulate me.


Purpl3Unicorn

I'm assuming by up/down you are taking about your INR. My mother has been on coumadin for decades. It's all about having a consistent diet. Vitamin K in particular will mess it up in an instant. If you like green leafy vegetables, you need to eat the same amount every day.


Admirable_Nothing

I didn't even like the monthly lab tests, so went to Xarelto, and simply have accepted the costs in exchange for no monthly tests. You state you are on Medicare. Doesn't Part D cover a lot of the cost? My Med Advantage plan pays 80%, which still leaves a chunk but a smaller chunk.


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Bamagirl31088

I have and those drugs are actually more expensive than the Eliquis


dee62383

Each visit to the doctor in order to get that blood work is another $35, though. That's part of where the snag comes in.


VerenValtaan

She should have standing orders for monitoring labs. There’s no reason to see the doctor every time for a routine monitoring lab.


Bamagirl31088

There was standing order but a copay is collected each time regardless


VerenValtaan

By the doctor’s office or the lab?


Bamagirl31088

Doctor’s office. You have to check in at the front desk then the lab comes to get after you’ve gone to patient services to pay the co pay


Admirable_Nothing

The Doc should not be charging you for that visit. he/she can order the monthly tests and you simply need to pay the lab fee. Once/year he can again reorder the next years monthly tests when you do your annual physical, which most insurances pay for.


dee62383

I just spoke to her, and Coumadin and the other meds don't play nice with her CVID or autoimmune diseases, so her current medication is the best fit.


invenio78

Doc here. Sounds like you guys explored all other options. CVID or autoimmune disease are typically not a contraindication for coumadin so I'm not sure where that came from? Eliquis is a "new" medication so we were using anticoagulants before Eliquis. I think there are really two options: 1) Pay for the Eliquis. 2) Try coumadin which is much cheaper.


dee62383

I'll have her read this. Thank you.


Bamagirl31088

Dr Thank you. I’ve been on Coumadin but we never could get the INR regulated. I was in the office three times a week for blood draws & had to pay a copay for each visit (even though it was just to the lab). He doesn’t want to go back that route bc it’s more costly that way vs the Eliquis. They gave me a one weeks supply bc Drug Reps in office visits have drastically reduced since COVID and they are only allotted x amount of samples. Even if we went the Lovenox route that’s still extremely costly. Medicare is NOT very friendly for the elderly and disabled bc they honestly don’t pay crap and it’s only going to get worse.


invenio78

You don't want to be on lovenox long term. But that's another topic. Most people can do very well with coumadin. Sometimes it takes some extra visit earlier on but most people get stable. I have some patients who have their own INR machines at home and they don't even go to the lab or my office, they test at home. Granted, most of our patients do a check their INR every 4 weeks at the lab.


Bamagirl31088

Insurance didn’t cover the at home INR machine we tried. It’s depressing as crap and you as a doctor get it bc yalls hands are tied just like ours are


wareagle995

Most people on Coumadin/Warfarin don't come in 3 times a week for labs. I work in a lab. It could happen at the beginning perhaps, but most come in once per week. Though you didn't say what the disorder was so I suppose there could be a more specific reason for 3 times a week.


dee62383

But she has CVID and autoimmune issues that weren't playing nice with those meds. Plus the meds weren't working very well for her.


wareagle995

What is the blood clotting issue?


dee62383

/u/BamaGirl31088, can you remember the name of it yet? (If you're willing to share)


wilder_hearted

I would suggest speaking with her provider about warfarin again. Initially, the INR needs to be drawn frequently to make sure she’s in a stable range, but this isn’t usually forever. Most of my patients on warfarin long term go once a month. There may also be a way for those lab visits to be cheaper elsewhere.


dee62383

What she explained is that other similar medications don't play nice with her CVID and autoimmune issues, so her current medication is best.


wilder_hearted

Obviously her providers know her best, but I’m not aware of any contraindication to warfarin with CVID. It’s an extremely old, well-studied, drug. She should ask for details. Another option (depending on her renal function and other comorbidities) might be therapeutic heparin. On rare occasions I’ve had patients on enoxaparin long term. That would be a daily, sometimes twice daily, injection she could learn to do at home (just like diabetics learn insulin).


dee62383

I'll have her read this. Thanks!


pookiebcute

Has she tried This application? Its seems a bit of a process to go through...but if she qualifies, she could get free. Never know... https://www.bmspaf.org/#home


dee62383

That's the patient assistance program from the drug manufacturer that she tried. Thank you, though!


Liquidretro

Was she rejected from it?


dee62383

They said she didn't qualify because she has Medicare.


christyopolis

Are there any community health centers nearby where she lives? I work at one and we have special government funding for prescriptions, called 340B. I don't know off the top of my head for Eliquis, but Xarelto (in the same family) is only $15 for a 90 day supply. Other meds are similarly priced - most around $10-15. There are some exceptions and sometimes you have to switch brands (Advair vs. Symbicort, for example - two common asthma steroid inhalers). All CHC's accept Medicare and with the exception of a few meds on the Walmart $4 list, meds through the CHC pharmacy are cheaper than retail without insurance. \*\*\*Caveat that I have only worked in Colorado but from my understanding other states also have 340B pricing even if they don't have Medicaid expansion.


dee62383

We have a place here in town that helps people pay for their meds one time here and there, but not every time. I'll at least tell her about that. As for everything else, I think she's already tried all the pharmacies near her, and it's too expensive at all of them.


EJB54321

The suggestion re community health center is to change her PCP to one of these clinics (called Federally Qualified Health Centers, or FQHCs) where she may be able to get the discounted 340b pricing. You can find out FQHCs in your area here. https://findahealthcenter.hrsa.gov


allison73099

Came here to say that! I’m in Oklahoma and we have them as well.


mydogisblack77

What other medication is causing $35 visits three times a week? Warfarin would be what comes to mind and that’s Bullshit. Source, I’m a clinical pharmacist who runs multiple anticoagulation clinics. For warfarin we test the inr (a finger poke blood test to see how thick or think your blood is) which does require repeat visits, but it takes 3-5 days to show a change so three times a week is way overdoing it. All of my clinics operate on a 1 week - 1 week - 2 week - 4 week - 6 week progression provided your inr stays therapeutic. This way if you do well you get to space the visits out further and further. This is standard practice. Warfarin itself is dirt cheap like two bucks a script. Eliquis has a generic approved but it won’t be coming to market for years, cause money. You can always ask for samples, but that’s hit or miss and not intended as a long term solution.


ChewieBearStare

It sounds like the doctor's office is charging her a $35 copay three times per week to draw blood. If that's the case, couldn't she ask for an order for an outpatient laboratory?


dee62383

Those medications also didn't work very well for her. Forgot to mention that. My apologies.


dee62383

She was having to go three times a week due to her having CVID and autoimmune issues. Plus the medication wasn't really working for her.


mydogisblack77

If you don’t mind my asking, what is she taking it for? For most coag disorders your choices are either warfarin or the doac’s (eliquis, xarelto, pradaxa) but there might be other options.


dee62383

Im not sure what her diagnosis is, but why she told me is that Eloquis is the only one that works and also doesn't mess with her CVID and autoimmune issues.


mydogisblack77

That is truly unfortunate. Really, warfarin is typically the best option for patients in her shoes therapeutically. There are two other options pursuing this going forward: 1) if possible, seeing if she qualifies for Medicaid instead of Medicare. Medicaid now covers eliquis for an average of $4/month 2) to help option one, get her set up with a social worker. We have one at my clinic who is a miracle worker. Patients like this who are in Medicare and struggling, she’s able to help them get qualified for either Medicaid or all these other programs that social workers deal with every day. They know how to work the system and get results.


dee62383

Others have also mentioned Medicaid. I will be sure to add this to the list of ideas. Thank you! Also, how would she go about getting a social worker?


mydogisblack77

Most clinics should have one on staff or the capability to refer her to one, especially if it’s a family medicine clinic.


dee62383

Thank you!


[deleted]

My only advice is to also try asking in r/povertyfinance and voice this issue to your local Medicare office if you haven't already


dee62383

I'll post there as well. Thank you for the tip!


GimmeBeach

Try calling 211. If the information and referral specialists can't find a consistent way to help pay for the prescription, they may be able to help your friend find support for other areas of her life that will free up money for the prescription. I didn't take note of where you're located, but 211 is available in almost every community, and many are available 24/7.


dee62383

We have 211 here. I'll let her know she has new comments to read. Thank you.


Witch-Tea8341

This isn't helpful today, but your friend should shop for Part D coverage every year during open enrollment in the fall. Each Part D plan covers drugs on different tiers(which can change at any time during the year). Eliquis is a pricey drug but another plan may cover it slightly better than her current plan. Most states have a Senior Health Insurance Information Program (or SHIIP) that can help you navigate the [Medicare.gov](https://Medicare.gov) website to see if a different plan will save you money. They may also have a list of other area programs that could help with copays. Good Luck!


dee62383

She's already on Part D, and has looked into every program. Lol.


Witch-Tea8341

Part D is just an insurance drug coverage product. You can change your part d plan every year during open enrollment to make sure you are getting the best coverage for your current medications. In my area, there are 30 different Part D plans and more than 70 Medicare Advantage Plans. It can be worth the hour or 2 it takes to research yourself at [Medicare.gov](https://Medicare.gov) or call either your Office of Aging for help or your SHIIP volunteer to guide your search. There should be no charge for this service with either of these offices. You could also call a Medicare Insurance Agent for the same service, just know they are paid by the insurance companies to sell certain products.


GomerGTG

I know it's been said a lot here but in the short term it sounds like her only options are: -go back to warfarin and see if she can get her labs drawn somewhere else cheaper -pay the ridiculous price for eliquis In the long term, what type of Medicare does she have? Is it traditional Medicare with part D prescription coverage? If so, is she on the donut hole for coverage? I'm betting she actually has a Medicare advantage plan. Those are offered by UHC, Aetna, humana and other places. They are cheaper premiums but are terrible coverage for meds, hospital stays, etc. She could look into the type of Medicare she has and what prescription costs are with other plans and try switching during open enrollment.


dee62383

I believe she has part D. She has a squeaky tight budget though, so I'm not sure what else she could afford.


Outlandishness-428

Are you sure she has Medicare instead of Medicaid? If so, which Medicare plan is she on?


Bamagirl31088

Medicare part a and b and Aetna Medicare as the supplement


galactica_pegasus

Does she not have a Part D plan? Part D would be the prescription coverage.


GomerGTG

I know it doesn't help right now but would consider getting part D prescription coverage instead of the Aetna advantage plan. On part D, eliquis is tier 3 and should be around $50. Not cheap but cheaper than what you are stuck with now. It sounds like your options are either find a way to pay for eliquis or talk to your doctor about finding a way to get your labs done cheaper/without the copay. Maybe instead of going to the office you go to a lab that is in network with your insurance and results are sent to your doc? Can also try and make adjustments to your diet before starting the warfarin in case that was part of the problem last time. Im so sorry you are dealing with this. I hate our system for things like this. The Medicare advantage plans are particularly frustrating. All the stuff they refuse to pay for/pass on to you is pure profit.


Outlandishness-428

As Medigap? If so, have you enrolled in Part D? Your Medigap policy likely doesn't cover prescription drugs.


TX2COMD

Most states Medicaid now cover xaralto, the doc may need to call them for an exception though. I can’t imagine if Medicaid covers it that Medicare doesn’t... also, lots of those programs won’t work on govt insurance. She could try a new pharmacy and say she has no insurance to see if that helps.


Outlandishness-428

Medicaid is an entirely different service than Medicare. I imagine the issue is her Medicare plan probably doesn't have prescription drug coverage - you have to enroll in either Medicare Advantage or a Medigap + Part D plan. The pharmacy can't do anything. I'd call the doctor, explain the situation, and see what the doctor's office can do. But without drug coverage, this person is kind of screwed.


dee62383

She's tried everything. Multiple pharmacies, too.


_cutie_pi

Hi pharmacy tech here! Have they used the 1 time free per lifetime free trial card as well? That will work if they have Medicare still. You can only get them from some doctors offices or directly from the drug reps.


dee62383

I will have her read these new comments, including yours. Thank you.


[deleted]

Assuming we are talking about someone who has a Medicare Part D plan, or a Medicare Advantage program, she may have to throw herself on the mercy of the manufacturer. I just checked a couple of Medicare Part D plans, and the lowest I'm seeing is $1300/year (deductible+drug cost+premiums) which isn't BAD for Eliquis - which will run you $500/month as on GoodRx for example, but not very friendly. So, short of either qualifying for Medicaid for the next 12 months or waiting until the next Part D open season finds her a better plan, she's going to have to try to find some way to minimize her costs. And choosing those plans may depend on what her other prescriptions are. Most of those exceptions of "Rx paid for by XYZ" are for people who are using government plans, so the thing is, she may actually be able to save money by getting the assistance plan alone. So, instead of using her health insurance card, use the assistance plan (or other plan) card.


dee62383

She tried to get the copay assistance card, and couldn't because she has Medicare. 🤷🏼‍♀️


spookibabi0115

Hi, I used to be a senior representative for Anthem's Rx insurance. Unfortunately Medicare is the most God awful insurance plan out there. It is the worst and there is not much you can do to lower the cost of medications through Medicare. However, if she is of lower income she can qualify for medicaid and become dual insured by the both of them. Medicare will be charged first and then medicaid would pick up the remaining cost. The only difficult process with this is medicaid can also be a pain in the ass and require her doctor to submit a prior authorization since eloquis is a brand name medication, but since there is no generic equivalent it shouldn't be too difficult. Oh and for anyone reading this - always have your doctor submit prior authorizations as urgent!! It cuts down the turn around time drastically (4 business days VS 3 business weeks.) Also editing to add, could I possibly get some additional info? Is she through straight Medicare or is she utilizing a managed Medicare policy? (such as anthem, Aetna, UHC, etc?) because I'm not too sure about the ins and outs of federal Medicare plans for pharmacy benefits, managed Medicare plans are generally more relaxed and willing to cooperate. So there may be options to call into the pharmacy insurance side of her plan and submit a request for a tier exception. Her doctor may need to also submit information as well attesting to the fact that the medication is medically necessary and that she cannot afford it. Again, always request these as urgent that way if they get denied you can appeal ASAP. I've been able to get eloquis down to the cost of a tier 1 for a patient before. It's gonna be an uphill battle but there are some options.


Clammypollack

There are foundations that have been established to help pay for medications for people with various diseases. I’m not sure if hers is represented by a foundation but it might be worth looking into


Bamagirl31088

Thanks I had checked and I’m at dead ends with every foundation and patient assistance program


johnsue30

she needs to get on a medicare advange plan with either humana, uhc, wellcare, or cigna. That will give her extra benefits eyes, vision, dental, as well as, small co pays for medication


dee62383

I will let her know about your idea. Thank you. 👍🏻


TacoHimmelswanderer

Contact the drug manufacturer a lot of them have programs to help people get their medications that are beyond their ability to afford


dee62383

She did. They told her she doesn't qualify because she has Medicare.


PoptartEthernet

Call the Medicaid office if she is on Medicare and can’t afford anything because of eloquis they will usually pick up the drug and will keep her from going in to debt she can’t pay


dee62383

Unfortunately I think if that were an option for her, she'd already be on Medicaid.


GreedyNovel

I don't understand. From https://www.goodrx.com/eliquis/medicare-coverage >99% of Medicare Part D and Medicare Advantage plans cover this drug.


Bamagirl31088

I have been to multiple pharmacies trying to use the goodrx coupon and they can’t use it bf I have Medicare and Aetna Medicare.


GreedyNovel

Looks like it might not be because you have Medicare, but rather because you don't meet the requirements listed here in order to be covered. >http://www.aetna.com/products/rxnonmedicare/data/2013/CV2013/anticoagulants.html I'd start by contacting the patient affairs person at your healthcare provider and see if that person can help navigate the maze. Most of them genuinely want to help if they can. Edit: I did that quite a bit myself when helping my Mom. My experience was that Medicare is generally awesome but you have be sure your ducks are in a row.


omgIamafraidofreddit

Any way to get to Canada? 3 month prescription? I would imagine Mexico is similar. >Eliquis costs $6.21 (in the US) compared to $1.60 north of the border. [https://www.nashp.org/is-it-safe-and-cost-effective-to-import-drugs-from-canada/#:\~:text=States%20and%20their%20consumers%20can,3](https://www.nashp.org/is-it-safe-and-cost-effective-to-import-drugs-from-canada/#:~:text=States%20and%20their%20consumers%20can,3).


Bamagirl31088

Oh how I wish!!! That would be wonderful but no way


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dee62383

It sounds like that's not something she can access right now: "The FDA generic approvals for Eliquis (apixaban) went to two drug companies . . . however, these two companies have not yet announced when U.S. sales will begin. Generic pricing is not yet available."


Bamagirl31088

There is NOT a generic available. I have proof from my cousins who are pharmacists as well as a pharmacist who commented on my fb post


[deleted]

Go to the news. They'll surely work up a good story about how ****** our system is if Medicare is endangeeing her life. Coming up at 9: when Medicare won't pay for the medication you desperately need. One local woman's plea to drug manufacturers. I'd watch it.


dee62383

I'd watch that, too!


Bamagirl31088

I havent sat on my ass lookin for hand outs...I’ve tried literally everything and it’s dead ends and sorry you have federal insurance. Basically I’m screwed. I’ve been on Coumadin and bc my body is a bi*ch I stayed up and down and continuously had to be monitored three times per week. Part of the issue is on top of the clotting disorder I have CVID and other autoimmune disorders..Some of the life saving meds for those issues butt heads with Coumadin. Eliquis was the best option. Last yr I paid anywhere from $45-$8 but this yr insurance changes and more bull 💩


LooksAtClouds

My elderly father-in-law was able to get an at-home test system about a year ago. Does the test at home once per week, then he calls the doc office with the result and they tell him how much coumadin to take.


Bamagirl31088

Insurance wouldn’t cover the at home INR machine nor was there any assistance for it


ImpossibleAcadia

Medicare usually covers home INR monitors. Could your pcp try ordering through a different company? Sometimes there are copays for test strips, but it usually balances out financially because warfarin is so inexpensive compared to Eliquis


LooksAtClouds

Can you contact a social worker or patient advocate in your doctor's office?


OfMastersAndMen

Who was adjusting your coumadin? I assume you tried to keep diet (leafy greens) consistent? Do you have much intake of vitamin K at all on a regular basis? Do you smoke or drink alcohol? Interacting meds aren't usually an issue with coumadin unless those meds are being adjusted in any way. Last resort for many of the patients I see is coumadin when they can't get a DOAC covered. I'm wondering if diet/meds need more consistency + a better provider needs to manage your coumadin if you have no other choice. In the long run, warfarin costs (drug + office copays) should only be slightly more expensive than a DOAC per some studies out there


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HazelNightengale

Been on it myself, and yeah...it is...even with "good" insurance.


AbjectIllustrator

Yes, you can use GoodRX with Medicare. https://www.goodrx.com/blog/yes-you-can-use-goodrx-if-you-have-medicare/#:~:text=But%20you%20can%20use%20GoodRx,pay%20at%20the%20same%20time.


dee62383

It doesn't always bring the price down, unfortunately.


Mathwiz1697

Not a doctor but work in a PCP office. I’m assuming your friend is under 65. However, is she is on Medicare, that would lead me to assume she is on Disability or the like, can she not gets a part D plan? Most of the cover either Eliquis or Xaralto. She may not qualify for a part D plan but it’s worth checking


dee62383

She is already on Part D if I'm not mistaken.


MiamiFan-305

Agreed on needing a part d or supplemental plan... If not warfarin maybe Plavix which is cheap? Pharmacist here.


dee62383

I believe she is already on Part D. I have let her know that she has new comments and hopefully she will read them.


tigobit

If she was rejected from the patient assistance program the manufacturer should have an appeal process. Even for patients with insurance or Medicare. She will have to prove the cost of the medication is too high even with the insurance help, so it involves getting a proof of cost from the pharmacy. She can also have her doctor write a hardship letter to the manufacturer on her behalf. I worked for a doctor and was in charge of the patient assistance program there, it's a lot of paperwork and phone calls, but I got a lot of people free meds just by jumping through the hoops multiple times, even after being denied.


dee62383

I will have her look at this. Thank you.


[deleted]

cant afford your medication? AstraZeneca may be able to help


dee62383

If only it were that easy.


mr78rpm

Manufacturers sometimes offer to help. I got that from a TV ad for a product, so I don't know how up and up it is.


dee62383

She tried that unfortunately, and doesn't qualify due to her being on Medicare.


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mrmayo26

This has been mentioned already, but if unable to get help from the manufacturer, (and in general), if they qualify for medical (income based) then they should sign up for that as well. Also they should switch to Coumadin, as someone else mentioned it is not 3 times a week, it is more often initially but some place have at home testing and as your INR (thinness of blood measurements) remains therapeutic then those appointments can be spaced out


dee62383

She's already on Medicare. And I think the snag with Coumadin is that it doesn't play nice with her CVID and autoimmune issues. And I also doesn't work for her. So it has to be the one she's on now. Or at least trying to be.


mrmayo26

Hmm they should double check. I’m a physician but I don’t know the ins and outs of their autoimmune disease but typically Coumadin is fine with most things, just need to adjust the dosing, which may require more frequent checks initially but again should even out. But I don’t know the ins and outs of the her situation but just saying. Good luck though


dee62383

I totally understand. And thank you for commenting! I appreciate you.


thethreatfulamoeba

I have had a patient with a very similar problem. She had fallen into the donut hole and during that time her doctor was able to give her enough samples to help her through the donut hole. Not sure if her current doctor is able to do that or not. Good luck!


dee62383

What did she do after the donut hole?


thethreatfulamoeba

After the donut hole the insurance went back to paying the majority of the prescription, so her copays went back to a similar rate as before entering the donut hole.


dee62383

Oh! Lucky girl!