HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Monday, June 12, 2006

The Donut Hole

No, not the yummy kind, unfortunately the donut hole in the Medicare Part D program (as you may recall, the program provides coverage for a subscriber's prescription drugs until he reaches a certain dollar limit, then it pays nothing (the hole), the program does start paying again but only after the subscriber has paid several thousand dollars of his own money to cover the costs of his prescription drugs) is about to become apparent to many new subscribers -- I don't think the result will be a pleasant one.  The New York Times has an article by Robert Pear on the impact of the donut hole  on Texas residents -

On May 2, Mr. Flores paid $20 for Plavix, a blood thinner used to reduce the risk of heart attack and stroke, and Medicare paid $109.62. But when he refilled the prescription at the end of May, he was in the coverage gap, so he had to pay the full amount, $129.62.

Mr. Flores is angry with Medicare, with his drug plan and even with the pharmacists who try to help him. He says no one told him about the coverage gap when he signed up.

Vanessa M. Recio, a pharmacist at Saenz Medical Pharmacy in Mission, Tex., said: "All I do all day is talk to angry patients. I process insurance claims and try to solve problems with Medicare."

The Times piece points out some of the other difficulties that individuals continue to have with Part D - including immigrants and pharmacists who have problems processings claims.  The Washington Monthly has a further examination of the politics of the  donut hole issue.  [bm]

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