Close the Doughnut Hole

Asclepios - Your Weekly Medicare Consumer Advocacy Update from the Medicare Rights Center Medicare’s Part D drug benefit has a built-in gap in coverage known as the “doughnut hole,” when coverage stops and consumers must pay the full cost for their medicine. The doughnut hole exists because the high cost of drugs made it too expensive for Congress to provide continuous drug coverage—the kind of drug coverage most Americans have through their employer-sponsored health plans. People with limited incomes can get coverage during the gap through a federal program called Extra Help, but for people with incomes or assets too high to qualify for this program, the effects of the gap on their health can be devastating. Here is what the studies show: * 3.4 million people with Medicare fall into the doughnut hole. * Over one-third of people with diabetes and hypertension fall into the gap. * Over 60 percent of people with diabetes, hypertension, congestive heart failure and high cholesterol fall into the gap. * Many people who fall into the gap skip doses or stop filling all their prescriptions, reducing their drug use on average by 14 percent. * Use of both generic and brand-name medicines to prevent blood clots drops sharply once people hit the gap, and continues dropping with each month they are in the doughnut hole. * One in ten people taking medicine to control diabetes stop taking their drugs when they hit the gap. The statistics are grim, but there is hope. Health reform legislation—HR 3200, America’s Affordable Health Choices Act of 2009—now making its way through the House of Representatives would phase out the Part D doughnut hole. The bill requires price concessions from drug manufacturers and uses the savings to help Medicare gradually narrow the coverage gap until, in 2023, it disappears completely. For the short term, the legislation also requires brand-name drug manufacturers to provide a 50 percent discount to people who fall into the doughnut hole, the result of a deal reached with drug makers, the White House and the Senate Finance Committee. Together, both provisions result in savings to Medicare of nearly $30 billion over ten years. Health reform legislation that passes Congress must include a plan to fully close the doughnut hole. Please write your senators and representatives and remind them to Remember People with Medicare in health reform and close the doughnut hole when they pass health reform.