Health First Health Plans is Here to Assist Medicare Advantage Members and Save on Prescription Drug Costs

By  //  March 20, 2020

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Help for the ‘Donut Hole’ Hurdle

Anyone with Medicare is familiar with the financial strain that can come with entering into the “Donut Hole” – a period of prescription drug coverage that requires members to dig a little deeper into their pockets.

BREVARD COUNTY, FLORIDA – Anyone with Medicare is familiar with the financial strain that can come with entering into the “Donut Hole” – a period of prescription drug coverage that requires members to dig a little deeper into their pockets.

Health First Health Plans wants to ease the burden on members’ wallets. In an effort to be the best prescription drug plan possible, the health plan is providing tips to Medicare Advantage members on how to reduce their drug costs.

“We’re here to help our members make the most out of their plans – and we want to save them money,” said Ron McGrier, Director of Pharmaceutical Services at Health First Health Plans.

“We know entering the Donut Hole can be costly and stressful for any senior on a fixed income. This is a challenge nationwide, and we are here to be a resource for our customers and show them how to save money.”

First, let’s break down the Medicare Donut Hole. It consists of:

An Initial Coverage Period where the member pays a cost-share according to their plan.

The Donut Hole starts when together, both the member and the health plan have reached $4,020 in total drug costs. During this period, members pay 25% of the cost of generics and 25% of the cost of brand-name drugs.

This Donut Hole continues until the member has spent $6,350 out of pocket on prescription drugs.

The Catastrophic Coverage Period begins after that threshold has been met. Then, Members pay 5% of their prescription drug costs or $3.60 for generics and $8.95 for brand-name drugs.

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While the Donut Hole can be worrisome to seniors on a fixed income, there are ways to soften the financial blow.

Health First Health Plans is eager to help members reduce their out-of-pocket expenses and recommends the following:

Call the health plan pharmacy department at 321.615.9426 to find out if your Tier 2 to 4 medications qualify for a lower-tier cost; if you qualify for a low-income subsidy; and if you can save on drug costs by switching to a 90-day mail-order supply.

Talk to your doctor. Your physician can review generic or alternative options that might be less expensive.

Take another look at your formulary (a list of brand-name and generic drugs covered by your health plan). Formularies can change from time to time, and you might discover some of your medications have changed to Tier 6 – which means $0 copay for members.
McGrier urges health plan members to reach out and find out where they can reduce costs.

“We want our health plan members to be well,” McGrier said.

“Reducing the financial burden of paying for prescription drugs is one way to help make that happen.”

Health First Health Plans is an HMO plan with a Medicare contract. Enrollment in Health First Health Plans depends on contract renewal. Y0089_EL8246_M Accepted 03152020

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