Medicare Part D has been a God-send for many seniors who may be on a fixed income and have a limited budget to spend on prescription medicine. However, for those senior citizens who have a chronic condition, the Medicare Part D coverage gap can be a startling realization. At the beginning of the second quarter of the year there is much talk regarding the donut hole or coverage gap. Why is it there, what is it, and how does it work?

To reduce the cost of Medicare's Part D coverage, the coverage gap was created. Each year, a limit for Part D is determined. $2400 was the 2007 annual amount. $2510 is what the yearly limit was increased to in 2008. $2700 is the limit in 2009. The amount is calculated on the total costs of the prescription medications that you receive. What the insurance company pays and your co-pays are included in this calculation. For instance, if a prescription medication costs $550 and the insurance company pays $500 and the patient pays $50, the amount that goes towards the annual limit is the full $550 the yearly amount is the entire amount of $550.

You are responsible for all of your drugs while in the donut hole. There are many Medicare part D plans that provide coverage for generic drugs when you are in the donut hole. This really isn't that much of a benefit because these Medicare Part D plans seem to cost more per month than most generics actually cost. It could be worth it to have prescription coverage for generic drugs for some patients because everyone's situation varies.

Chronic conditions which often require costly prescriptions for treatment result in Medicare Part D patients reaching the coverage gap in a matter of a couple of months. Reaching the donut hole as early as February is not uncommon. Encouraging patients to use less expensive prescriptions when possible is the whole point for the coverage gap. This punishes those patients who must take costly prescription medicine because nothing else works. Patients whose rheumatoid arthritis is successfully controlled by Enbrel can fall into the donut hole or coverage gap within two to three months because of the price. The option at this point is to pay for the prescription medicine at full cost for several months until the catastrophic coverage portion applies or suffer the potentially disabling consequences of stopping their prescription medicine. Approximately $1500 a month is the cost of Enbrel. There are very few senior citizens who can afford that.

Some people will be able to qualify for patient assistance programs because of their income levels. One of the best ways to get low cost or free prescriptions is to talk to the drug manufacturer. Contact the company and ask about their Prescription Assistance Program. Almost all drug manufacturers offer these programs, which enable people to receive medicine they need at a price they can afford. A lengthy application co-signed by your physician is typically necessary for entry into the program. Patient Assistance Programs run by drug companies have been in existence for over 23 years. These programs are designed to help eligible individuals who can't afford their medicine due to limited income or other financial hardships.

Drug companies did not want their low income patients to be forced to make a choice between paying for life saving drugs or for paying for rent or groceries. As a result, patient assistance programs came into being as part of the company's philanthropic efforts. Until relatively recently, few patients knew about these programs or could follow the complicated application process that was required for participation. In many cases multiple applications had to be filed with several different drug companies in order to gain access to prescription assistance programs.

The drug manufacturers seem to believe that providing information on their websites and toll-free numbers is all that patients need to access PAPs. They don't appear to appreciate the inability of many people, particularly those on several drugs from 2 or more doctors to follow through with the lengthy application process. It also places an unfair burden on the physicians that are already swamped with paperwork. Fortunately there are companies that will perform the task for people for a fee. These prescription assistance companies will generally coordinate the process from beginning to end. Of course the prescriptions are free and if people have the ability to do it themselves they should, but for those patients that just don't have the ability to do it themselves, the hiring of a company to do the job is a better option than not taking the medications they need.