Asclepios
The Expanding Doughnut Hole
September 24, 2009 • Volume 9, Issue 38
Every year, as prescription drug costs rise, the gap in Medicare drug coverage grows larger, and more older adults and people with disabilities fall into it. Very few ever get out, and so they wind up paying the full cost of their medicine and their drug premiums for the remainder of the year.
At last count, there were 3.4 million people with Medicare in the coverage gap, or doughnut hole, in the Part D drug benefit—the gap when coverage stops and people with Medicare are forced to pay the full price for their medicines. This 3.4 million includes over 60 percent of people with diabetes, hypertension, congestive heart failure and high cholesterol. Once people hit the gap, they use the same risky strategies that they employed before there was any Medicare drug benefit: they skip doses, split pills or stop taking their medicine altogether.
The situation is bad now, but it will grow much worse unless we act. The amount people need to spend to get out of the doughnut hole is projected to nearly double to $6,000 by 2016.
Both President Obama and the lawmakers who wrote the House health reform bill, HR 3200, have proposed to phase out the doughnut hole. Each year of the 12-year phaseout means a significant improvement in drug coverage; the doughnut hole starts later in the year and ends earlier.
Today, the Senate Finance Committee had the opportunity to close the doughnut hole by voting for an amendment based on HR 3200. Under the amendment, the phaseout of the doughnut hole was fully paid for by securing price concessions from drug manufacturers. Unfortunately, the amendment, sponsored by Senator Bill Nelson, Democrat of Florida, was voted down 13 to 10.
That is a setback, but it’s not the end of the road. If we use today’s defeat to mobilize and let all our senators and representatives know that there is broad support for closing the doughnut hole, we have a good chance of getting a health reform bill that includes this important improvement to Medicare drug coverage. Please write your senator and representative and urge them to Remember Medicare and close the doughnut hole in health reform.
Medical Record
“I work as a resource specialist for the Hematology/Oncology department at a major teaching hospital in Boston. Each and every year there comes a time when all my Medicare patients come to me in a panic because they have hit their donut hole. Lately, because of rising drug costs, it has been happening earlier and earlier on in the year. It used to come up in September, but I have seen an increasing number of my patients enter the donut hole as early as March through June.
I watch as they try to decide whether to stop paying for their life-sustaining medications or to cut back in other areas, such as food or rent. No one should have to face this decision, EVER.
When I first started working in this position, I couldn't believe that the donut hole was actually designed to exist. I thought that there must be a loop hole or way around it. I quickly learned that although I am lucky to be working in MA where there are one or two options for low income Medicare patients, many others are far worse off. It is beyond distressing when I have to explain this to patients.
I have looked into any and every assistance option for my patients. Sadly, I have also learned about the flaws in the assistance programs as well. I'm supposed to help my patients and I end up just as discouraged as they are a lot of the time. Some have been eligible for assistance, but I have seen many patients drain their modest life savings to be able to pay for their life-sustaining medications.” (Story submitted to Medicare Rights Center from Boston, Massachusetts, September 24)
* * * *
Medicare Part D Appeals Help for Advocates Is Here!
Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Register for a FREE copy of this great resource.
* * * *
Medicare Part D Monitoring Project
The Medicare Rights Center would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
* * * *
The Louder Our Voice, the Stronger Our Message
* * * *
Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
* * * *
The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
Visit our online subscription form to sign up for Asclepios at http://www.medicarerights.org/about-mrc/newsletter-signup.php.
Get answers to your Medicare questions from Medicare Interactive at http://www.medicareinteractive.org.