The cost of prescription drugs can easily add up to hundreds of dollars per month for an individual without insurance. Even for kupuna with Medicare, once they reach the "coverage gap" they are paying 100 percent of the costs until they reach catastrophic coverage. Is there any help out there for people in Hawaii struggling to pay for prescription drugs?

Let us first look at individuals with Medicare.

Medicare offers prescription drug coverage to all of its members in Hawaii. There are approximately 34 companies in Hawaii offering 74 options for prescription drug coverage. The basic Medicare Part D plan looks like this:
• A monthly premium (average in Hawaii is about $25)
• Annual deductible of $295 (the individual pays this before the plan helps pay)
• Twenty-five percent co-insurance (the individual pays) for a portion of the drug costs between $295 - $2,700, which is approximately $601.25
• After the plan and individual together have paid $2,700 for the cost of the drugs (that would be the actual cost of the medication) – the person is in the "coverage gap" – also known as the donut hole. The individual is now responsible for 100 percent of the cost of the drugs for the next $3,453.75.
• Catastrophic coverage occurs when the person pays $4,350 out of pocket – this includes the annual deductible, 25 percent co-insurance and the coverage gap ($295 + $601.25 + $3,453.75). At this point, the Medicare plan will pay 95 percent of the cost of the drugs for the rest of the year.

Some plans will offer extra benefits above the basic plan (no deductible, coverage of generic drugs during the gap) and Medicare also provides extra help for individuals if they have limited income and assets. The "extra help" from Medicare may help pay for the drug plan premium and the deductible, and they will have continuous coverage (no donut hole). In 2009 to qualify, an individual’s gross monthly income must be less than $1,557.50 per month and their assets (not counting home and cars) must be less than $12,510. For a married couple living together they combine the incomes, for a gross monthly income of less than $2,095 per month and assets less than $25,010.

The application can be done online at www.socialsecurity.gov or by calling Social Security at 1-800-772-1213 or by calling a volunteer from the Executive Office on Aging's Sage PLUS Program – the Hawaii SHIP (State Health Insurance Assistance Program) at 1-888-875-9229. The Sage PLUS Program is a volunteer-based program, funded by the Centers for Medicare & Medicaid Services, that provides assistance to individuals with Medicare. Sage PLUS volunteers can also help you compare the plans available to help you choose the plan that will best fit your needs.

For individuals who are not yet eligible for Medicare or for Medicare members in the coverage gap who do not qualify for Medicare's extra help, many of the drug companies have patient assistance programs (PAPs) that may help pay for the cost of the drugs. Each company has its own guidelines to qualify for these programs. Many of them look at only the gross income of the individual. To find out if you may qualify for the patient assistance programs, there are several Web sites that you can go to (Note: if you have Medicare and utilize a PAP, it will not count toward your out-of-pocket costs for catastrophic coverage):
• www.needymeds.org
• www.rxassist.org
• www.pparx.com (1-888-477-2669)

Several of our pharmacy groups in Hawaii are also offering generic prescription drugs at very reasonable prices for 30 and 90-day supplies. You may need to check with them to see if the generic drug that you are taking is included as they do not cover all generics.

Don't be afraid to talk with your physician when he or she prescribes a new medication. Ask if there is a generic drug available; or if the medication is too expensive, inquire if there is another drug in the same class of drugs that will work for you. Take your medication as prescribed and keep an open conversation with your physician and pharmacist. Practice healthy habits: eat right, exercise daily and keep smiling.

If you have questions about Medicare benefits or if you would like to become a Sage PLUS volunteer, contact us toll-free at 1-888-875-9229. We are a volunteer-based program, so you may need to leave your name, phone number, zip code and the island you live on and a volunteer will get back to you in two working days.