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Effect of Medicare Drug Coverage 'Doughnut Hole' Is 'Troubling'
for Beneficiaries With Chronic Conditions,
Editorial States
[Sep 02, 2008]
The effect of the "notorious 'doughnut
hole'" in Medicare Part D plans is "very
troubling" for beneficiaries with serious
chronic health conditions, a
New
York Times
editorial states.
The so-called doughnut-hole spending gap
takes effect when total drug spending for an
individual reaches $2,400 for a single year
and continues until total out-of-pocket
spending reaches $3,850 in that year, at
which point the beneficiary receives
catastrophic coverage.
According to an analysis recently
conducted by the
Kaiser Family Foundation,
Georgetown University and
NORC at the University of Chicago, 3.4
million Medicare beneficiaries reached the
coverage gap in 2007.
The
Times states that it is
"disturbing" that across eight classes of
drugs studies, 15% of the beneficiaries
halted their medication when they reached
the gap.
The
Times notes that an additional
1% of beneficiaries who reached the spending
gap reduced the number of drugs they were
taking and 5% switched to less-costly
medications.
The editorial continues that the health
consequences for the 10% of diabetics who
stopped their medication after reaching the
coverage gap "could be immediate and
serious," while the harm to beneficiaries
with other chronic conditions -- such as
high cholesterol or osteoporosis -- "could
take longer to show up but could still be
serious."
According to the
Times,
"There is no easy solution short of
increasing federal spending or finding a way
to drive down the cost of drugs." However,
the editorial concludes, "The next
administration and Congress will have to
revisit the wisdom and need for the gap" (New
York Times, 9/2).
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