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Stop the Punishment: Fix the Medicare Doughnut Hole Today

  • by
  • August 12, 2009
  • 11:48 am
Stop the Punishment: Fix the Medicare Doughnut Hole Today

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

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Photo adapted from iclipart.com - used with permission.

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21 comments

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3:06PM PDT on Sep 2, 2009

There are so many in the White house, you should think of them as a corporation. A corporate meeting does not happen over night.Things have to be hammered out, and this does not take a day...The old saying is Rome wasn't built in a day..nothing is built in a day...Everybody is so paranoid, and in a rush....You should'nt have voted for the Bush administration...There it is, and there it was...

9:37PM PDT on Aug 16, 2009

Sign this petition to fix the prescription drug benefit.

http://BIT.LY/drug_benefit

11:56AM PDT on Aug 14, 2009

those who have good or great health insurance WONDERFUL
Please help the rest of us get it

REMEMBER WE PAY CONGRESS
WE PAY FOR THEIR HEALTH INSURANCE
even if it is a watered down version of what congress has it will be better then what I am paying for now

the asthma medication jumped from $7.00 to $30 Dollars because the insurance company took it off the Generic tier
"Diabetes is a staggering epidemic affecting nearly 24 million Americans and another 57 million with pre-diabetes. " 1/3 of my medications are NOT Offered in Generic form that means I pay $30 or MORE for medication that keeps me alive. and I would not have developed Diabetes if I had Health insurance that could have and would have payed for the doctors, tests and procedures that could have stopped the underlying cause that triggered my diabetes. I had to come within an HOUR of dying before someone found out what was wrong with me. and then it took 4 YEARS to jump through the insurance hoops to get help
and now we are in debt to the tune of over $55,00.00 because the insurance company would not pay for most of it even after getting approval

SOMETHING HAS GOT TO CHANGE AND FAST

I will not be able to change insurance companies now because of preexisting conditions.
and what I have now can drop me at any time.

I am on the brink of being uninsured

and I don't qualify for Medicare
or any other medical assistance Government or other.

SO PLEASE HELP US!!!!

11:06PM PDT on Aug 13, 2009

It's not only drug companies, but drugstores too. A Rx from Walgreens/CVS costs $50+, if you buy it at Costco (no membership needed for Rx) it costs $10 - pretty much the same mark-up for higher cost Rx... so people need to know - if your insurance doesn't cover it or you've reached the doughnut hole - there is a more affordable place to get Rx while they're flipping quarters over health reform. Yes - the GREED factor is well and alive for now, so take the initiative and go to Costco

9:28PM PDT on Aug 13, 2009

They need to try to buy med.with what we have to live on.
We all need the same kind of ins. they have are they need to try living on S.S.and see how they can afford to buy med.

5:09PM PDT on Aug 13, 2009

First - I am appalled that the Democrats we elected on the understanding that we wanted change are somehow confused. They seem to think that change means regressing to Republicanism of the 1950s! Can you imagine the ecstasy that Nixon, Goldwater, and the gang would be in if they could have achieved what our supposedly "progressive" majority in Congress and not at all progressive president have given us?

If they were true progressives, the first step would have been to restore Medicare to pre-Reagan/Bush status. What on earth is stopping them? They keep trying to appease Republicans - and Republicans LOST big time. What about appeasing those of us who sent them money and voted for them? We want to eliminate all the terrible changes to Medicare, not just the Doughnut hole - which has caused people I know to have to sell their houses! - but also taking a large premium out of Social Security (over $90 a month), not to mention the premium - $30.37 a month for Part D drug coverage. Try living on social security and losing $120.00 a month - and that's just in 2009 - it goes up every year. Supposedly Medicare is paid for as you work - but almost no one knows that there are payments required once you receive Medicare. And that's just the beginning - add in the doughnut hole, add in co-pays: one friend had to stop going for check ups because her co-pay was $110! Add in that many clinics don't take Medicare. We have to have real change and right now.

1:08PM PDT on Aug 13, 2009

I think that this is a nobrainer of course the do and that is a fact!!!

11:21AM PDT on Aug 13, 2009

continue-
As I have written weekly letters, way before they whole health care reform began, to my representatives, senators, congressmen. If they chose to vote "no" on health care reform. Then the next time my mother calls me crying that she only has $9.00 left for groceries for the month or is unable to refill their prescriptions -I'll just have her call THEM, so THEY can explain to her WHY the health insurance companies AND pharmaceutical companies are more important than HER!!
We DID NOT elect our representatives, senators etc to work for corporate America! We elected THEM to work for "We the People"!
If you do some research on exactly how much money our elected officials are receiving from private health care providers and pharmaceutical companies, then people would understand WHY they are spreading rhetoric and voting NO on health care reform!!!
It IS HIGH TIME that our elected officials are NO LONGER ALLOWED to receive money from corporate America!! Maybe then they would actually be working for "We the People" instead of corporate America!!!!!!!!!

11:12AM PDT on Aug 13, 2009

The current health care system AND pharmaceutical companies has been destroying our country for decades!
My senior citizens parents are on social security, medicare and one receives a small pension (aka fixed-income).
If it wasn't for the skyrocket cost of prescription drugs and the current health care system, my parents would be far better off than they currently are.
Unfortunately, the cost of their prescriptions (average of $800-$1000 PER MONTH EVEN with using Medco thur bcbs!!), the current monthly cost for their "private" health care provider (bcbs), and medicare is an average of $1400-$1600+ total per month! The cost of this has them in dire straits and sadly, they keep having to do without medications so they can pay their mortgage, monthly bills etc!!
It greatly angers me, that this situation is a HUGE strain on my parents, myself and the rest of my family! And IT is doing NOTHING but adding to a decline in my parents health, as well as mine!
Also, it is not only a financial strain on my parents but also a financial strain on my entire family!! Since we keep having to send them money so they can continue to take their medications AND PAY THEIR MONTHLY BILLS!!

In November of 2008, as everyone should surely know by now, America VOTED FOR CHANGE! Now is the TIME FOR CHANGE, not more of the same and NOT in the better interest of corporate America!!

As I have written weekly letters, way before they whole health care reform began, to my representatives, sena

10:39AM PDT on Aug 13, 2009

60% of bankruptcies in this country (us) are medical bankruptcies and 78 percent of those people HAD insurance. and the study I get these figures from took place a full year before the recession.

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