Closing Medicare's Drug "Doughnut Hole"

[babylonsister]

Just an fyi for those with questions...

Closing Medicare's Drug "Doughnut Hole"

Monday 29 March 2010

by: Christopher Weaver | Kaiser Health News


Washington - Now that the health care overhaul has passed Congress, Democratic lawmakers are hoping to highlight its most immediate benefits. Chief among them: a plan to help millions of elderly and disabled Medicare beneficiaries pay for their medications by gradually eliminating a prescription-drug coverage gap commonly known as the "doughnut hole."

"Who among us will not be more secure knowing that our parents will be protected from the Medicare Part D 'doughnut hole,' which has made lifesaving medications so unaffordable for those that need them most?" Rep. Lucille Roybal-Allard, D-Calif., said after the vote on the legislation in the House of Representatives.

The doughnut hole is a complicated contraption, however, and filling it is far from simple. Here's a close look at how the doughnut hole works and how it would be closed.

Q: What is the doughnut hole?
A: In 2003, Congress passed legislation that created the Medicare drug benefit, which went into effect in 2006. Private insurers offer the benefit through free-standing drug plans and Medicare Advantage plans, which also offer medical benefits.
The Part D plans have some leeway in how they design their coverage. Under the typical benefit for this year, however, beneficiaries have to pay deductibles of $310 and monthly premiums that average $38.94. After they meet the deductible, beneficiaries are required to pay 25 percent of their drug costs; their drug plans, which the government subsidizes, pick up the rest.
Once total spending by the patients and their drug plans exceeds $2,830, the beneficiaries hit the coverage gap, in which they must pay the full cost of their medications. After they spend another $3,610, they're eligible for what's called "catastrophic" coverage, under which they pay only 5 percent of their drug costs.

Q: What will the new law do to close the gap?
A: Beginning this year, any Medicare beneficiary who reaches the doughnut hole will receive a $250 check to help pay for his or her drugs.

Then, starting in January, patients in the coverage gap will get 50 percent discounts on brand-name drugs. The drug companies will finance the price reduction as part of a deal with the White House, in which the industry made tens of billions of dollars in price concessions.

The federal government will play a big role, too, in closing the doughnut hole. In 2013, the government will begin providing subsidies for brand-name drugs bought by seniors who hit the coverage gap. The government's share will start off small, at 2.5 percent, but will increase to 25 percent by 2020. At that point, the combined industry discounts and government subsidies will add up to 75 percent of brand-name drug costs.

Generic drugs — which cost far less than brand-name drugs do — will be dealt with separately. Beginning next year, government subsidies will cover 7 percent of generic drug costs once people hit the doughnut hole. Washington will pick up additional portions each year until 2020, when federal dollars will cover 75 percent of generic drug costs.

At that point, the doughnut hole effectively will be closed.

more...

http://www.truthout.org/closing-medicares-drug-doughnut-hole58119

[Clio the Leo]

1. Leader Reid served donuts to those traveling to protest him this weekend...

.... I'm not kidding. His office set up a welcoming tent welcoming the visitors to the area and offering them donuts to celebrate the closing of the Medicate donut hole.

You gotta love that attitude.

[Cleita]

2. I just got my drug explanation of benefits today.

I get up to $2,830 in total drug costs. After that I have to pay 100% up to $4,550 in TrOOP, a mysterious thing called True Out-of-pocket Amount. So far I have paid $31.11 in TrOOP and the plan has paid nothing. ??? After $4,550 in TrOOP I pay the greater of either 5% coinsurance or up to a $2.50 copayment for generic drugs or $6.30 for all other drugs for the remainder of the coverage year. I really don't understand this and fail to see where it has plugged much of anything, either donut hole or otherwise.

[IndianaGreen]

4. What hole is being plugged is the question, isn't it?

:think:

[DURHAM D]

3. What's wrong with this whole thing is lack of emphasis on bulk buying power.

The whole reform is about taxpayers/government spending going up but nothing about drug expenses really going down. Profits, profits, profits for drug makers with a growing built in client base. Motherfuckers.

[Cha]

5. K & R

[Vinca]

6. Medicare Part D needs a major overhaul and closing the donut hole is a good start.

Next up should be allowing bulk buying of drugs by the government and reimporation from the sane countries that actually regulate big pharma. They should also standarize insurance plans. It's idiotic to expect someone to choose a policy from one company in January, based upon what they might or might not need in July. Every policy should cover every drug.