Many Americans rely on Medicare not only for their healthcare needs, but also for their prescription drug coverage, too. Medicare Part D is a program that provides prescription drug coverage to those enrolled in one of the many prescription coverage programs available to them (in some states, Medicare beneficiaries must choose from among 50+ plans). If the shear complexity of choosing a program wasn’t enough for most Medicare beneficiaries (most of whom are older and on fixed incomes), the program has the standard features one would find with most other prescription programs: deductibles, co-pays, and maximum coverage limits.
Perhaps one of the most significant flaws in the program is what most experts and advocates call the “Medicare Part D “doughnut hole” in coverage. The doughnut hole is a gap in coverage that exists from when an enrollee reaches their plan’s maximum coverage for the year (at approximately $2500-$2700 per year) to when they get to the catastrophic level of prescription costs, which happens when their drug costs reach $4,350 (for 2009). During this gap, or doughnut hole, enrollees must pay 100% of the cost of their drugs.
Just as an example, I did a search for clopidogrel (Plavix), which is a drug that many people with heart disease take to prevent blood clot formation. Drugstore.com lists this drug, for $429.96 for what would be a month’s worth of drug if a person was taking 225 mg per day. This is for one drug. Most people, as they age, need more than one medication, and oftentimes are on 4-5 medications just to manage mild forms of chronic medical problems. It’s easy to see how quickly this could add up for seniors who have fallen into Medicare’s doughnut hole.
The problem here is not just dollars and cents. The problem is suffering, pain and perhaps, loss of life. Many seniors who can’t afford their medications simply don’t take them. A new study out from the Kaiser Family Foundation found that in 2007, 3.4 million people reached the doughnut hole in coverage and of those, 15% (or 510,000 people) stopped taking their medications because of it. The study found that 10 percent of Part D enrollees taking medications for diabetes who reached the coverage gap stopped taking their medications. If someone with diabetes stops taking their medication, their blood glucose levels will soar, and assuming they don’t die from this, they could suffer other health consequences such as kidney damage, vision loss, or decreased circulation to the lower extremities.
President Obama recently struck a deal with some pharmaceutical companies to help cover some of the cost of medications for people who have exceeded their Part D coverage limits. This will help, but more needs to be done. If you don’t want America’s seniors to be left out in the cold when it comes to prescription drug coverage, take some action now. Visit the petition below and tell Congress to close the doughnut hole and ensure that Americans who need their prescriptions the most can afford them. I’d also like to hear what other ideas you have about prescription drug coverage.
Petition: Close the Prescription Doughnut Hole
Photo adapted from iclipart.com - used with permission.