Medicare Humana Donut Hole

Vanessa2U

Vanessa2U

New Member
I'm taking Ozympic and the Medicare part c insurance company Humana will only help me out the first 6 months. After that I enter the donut hole where my cost goes way up. Now they're wanting $200 for one month supply of Ozympic. That is one pen.
I make too much money to get extra help and not enough money to be able to pay $200 per month for the rest of the year. There aren't any coupons for me since I'm on Medicare.
How do you all get through this donut hole?
 

Pepper said:
Are you not diabetic?
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I am type 2 diabetic. On my next doctor visit in a week or so I probably won't be considered type 2 anymore because my A1C is going to be really low. But that's because of the Ozympic. It really does work. I've lost 25 lb and my A1C is probably going to be a six when I see my doctor. That's why I really would love to stay on Ozempic but I just don't know how it's going to be possible.
 
I live in New York State, we have a program called EPIC that helps with prescription costs not covered by the Medicare donut hole.

I have to pay a $250.00 deductible because my income is above the minimum and below the EPIC cap of around $80,000.00/year.

After I meet the deductible my Ozempic goes back to it’s normal deductible of around $42.00/month.
 
Well that's good to know. I guess I'm going to have to look into this more to find a way to pay for this.
If I might ask why are you taking Ozempic? My A1C was 10😔 the last time I went to the doctor. I've lost 25 lb since then and my BG numbers are averaging around 110. So hopefully my A1C will be down this next time I visit the doctor. I was able to get off of insulin due to taking Ozympic.
 
Vanessa2U said:
Well that's good to know. I guess I'm going to have to look into this more to find a way to pay for this.
If I might ask why are you taking Ozempic? My A1C was 10😔 the last time I went to the doctor. I've lost 25 lb since then and my BG numbers are averaging around 110. So hopefully my A1C will be down this next time I visit the doctor. I was able to get off of insulin due to taking Ozympic.
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I was in Trulicity as one of several medications to treat my diabetes. My PCP switched me to Ozempic to shake things up a little and also avoid some of the supply chain issues I experienced with Trulicity.

For me, the most effective tool to treat my diabetes has been a CGM glucose monitor.

It works with a sensor placed on the arm that communicates with my iPhone or a base unit supplied by the manufacturer. It tracks my glucose 24/7 and sends alarms when my glucose is out of the target range.

So far there has been no charge to me. The entire cost has been picked up by Medicare as durable medical equipment.
 
Aunt Bea said:
I was in Trulicity as one of several medications to treat my diabetes. My PCP switched me to Ozempic to shake things up a little and also avoid some of the supply chain issues I experienced with Trulicity.

For me, the most effective tool to treat my diabetes has been a CGM glucose monitor.

It works with a sensor placed on the arm that communicates with my iPhone or a base unit supplied by the manufacturer. It tracks my glucose 24/7 and sends alarms when my glucose is out of the target range.

So far there has been no charge to me. The entire cost has been picked up by Medicare as durable medical equipment.
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I was on Trulicity also at one time. And then I had to switch to Tresiba which is insulin.
I did get a CGM free of charge and I wore it for a little bit and it just wasn't matching what my meter was showing plus I didn't like wearing it LOL so I ditched it. I don't mind pricking my fingers.
 
I have Humana as my Medicare advantage insurance and it pays pretty much for all my medications until I hit July and then it puts me in the donut hole so Ozympic costs a fortune. How much Ozympic do you take and are you never in the donut hole? I take 2 mg per week.
 
I must say I am surprised Medicare pays for it. I believe they should for people with diabetes and problems leading to it.

It has so much become a designer drug for the famous and for people with money. I think that misuse of the drug drives the price up for those who medically need it, can't afford it. It also can lead to a shortage for those that take it for medical reasons.
 
Blessed said:
I must say I am surprised Medicare pays for it. I believe they should for people with diabetes and problems leading to it.

It has so much become a designer drug for the famous and for people with money. I think that misuse of the drug drives the price up for those who medically need it, can't afford it. It also can lead to a shortage for those that take it for medical reasons.
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Medicare pays for it because it's to treat type 2 diabetes. The plus is that you also lose weight. And yes the movie stars did use it and there was a shortage. But now they say there is no shortage.
 
I was just informed by Aetna that I am now in the donut hole. The cost of my Xarelto and Farxiga will go sky high until the end of the year. How I will deal with it is a question. They are said to be eliminating the donut hole in January. We shall see.
 
Alizerine said:
I was just informed by Aetna that I am now in the donut hole. The cost of my Xarelto and Farxiga will go sky high until the end of the year. How I will deal with it is a question. They are said to be eliminating the donut hole in January. We shall see.
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The donut hole is going away but we may still have some hefty out of pocket expenses, copays, etc…

CMS Releases 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonstration | CMS

On my next PCP visit I’m going to discuss lower cost alternatives to the high priced drugs like Ozempic.

IMO life should be a comfortable balance between the necessities, and a few luxuries, not a burden due to high cost and low rewards in any one area.
 
Aunt Bea said:
The donut hole is going away but we may still have some hefty out of pocket expenses, copays, etc…

CMS Releases 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonstration | CMS

On my next PCP visit I’m going to discuss lower cost alternatives to the high priced drugs like Ozempic.

IMO life should be a comfortable balance between the necessities, and a few luxuries, not a burden due to high cost and low rewards in any one area.
Click to expand...
Well you know, the gov isn't going to help us too much. As always...
 
I found a way to get Ozempic for $0. They've sent me 4 boxes, enough to last through December 2024.
I had applied but never did hear back from them. I called Nova and the lady told me my doctor had filled in one line incorrectly. The Nova rep said she called my doctor, left a message but never heard back.
I called my doctor, she filled the form correctly. I called Nova a week later and the lady said I was approved and would be receiving pens.
Here's is where you need to go. I might add, you have to fill in your portion and your doctor fills in his.
Novo Nordisk Patient Assistance Program (PAP)
 
New to all this starting Sept 2024. Used medicareschool.com and all went well.

Just had a call with Medicareschool.com for 2025. pardon my language but JFC!!! I don’t fully understand everything but the deductible is capped at $2k for 2025 and three of my drugs were dropped and now my part D is looking like $16k because I have to pay like full bore. That’s only part D!!!

Invokana, Victoza, and Saxagilpin are the killers.

May be able to get alternates but this absolutely nuts. Thought I knew where we were as new retirees but now I’m bummed.
 
Once again glad I have the Advantage plan our plan coordinator set up for us. The only tier 3 med I have prescribed is Eliquis. The donut hole cost was around $485.00 the last delivery of 100. This is from our plan coordinator.
Quote
"Around this time you should be receiving your Annual Notice of Change from your plan. I will be contacting you directly for any drastic plan changes (if any).
2025 Prescription Drug Changes for all Medicare beneficiaries:

- $2,000 maximum prescription drug cost cap.

- Elimination of the Coverage Gap/Donut Hole (which is great!)

- Monthly payment plan option for drug costs available through your plan."

The max I'll pay in 2025 is $47.00 for each 100 day supply. That I can get reimbursed from my HSA. Our meds are on auto refill. That means when we are due for any refills the pharmacy calls the prescribing doctor & gets that done electronically. We don't have think about watching the quantity or contacting a prescriber for refills.

Life is good.
 
Aetna contacted my cardiologist and I am to pick up samples of Xarelto and Farxiga tomorrow. I need enough for the rest of the year and those sample packets usually contain enough for one week. Let's hope they are generous. Darn donut hole.
 

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