Drug
Plan coverage for seniors in 'Doughnut Hole' will be scarcer, less
affordable in 2007… In 13 states, no drug plan will provide
"Doughnut Hole" coverage in 2007 for the top medicines prescribed to
seniors-up from four states in 2006…Premiums to increase by at least
87.4 percent next year for drug plans offering "Doughnut Hole"
coverage for the top medicines
In 13 states next year, there will be no drug plans that offer
coverage in the so-called "doughnut hole," the big drug coverage gap
in the Medicare Part D prescription drug program, for the top
medicines prescribed to seniors, according to a new report issued
today. In 2006, there were only four such states, but the number of
seniors without access to such doughnut hole coverage will increase
from 375,000 to 6.6 million in 2007 - an 18-fold increase.
In the 37 states and the District of Columbia in which plans
will continue to offer such doughnut hole coverage, premiums
for the lowest-priced Part D plans will increase by 87.4
percent, jumping from a median monthly price of $55.08 in
2006 to $103.20 in 2007 (an increase in annual premiums from
$660.96 to $1,238.40).
The report, issued by the health consumer watchdog organization
Families USA, contradicts the Bush administration's claims that in
2007 "there will be more plans with coverage in the (doughnut hole)
gap." According to the report, the four states (Alaska, Hawaii,
Maine, and New Hampshire) that did not have plans with meaningful
doughnut hole coverage in 2006 will be joined by nine additional
states (Connecticut, Florida, Massachusetts, Michigan, New York,
North Carolina, Rhode Island, Vermont, and Wisconsin) in 2007.
In 2006, the doughnut hole coverage gap begins once a senior has
$2,250 in drug costs. When a senior reaches that threshold, the
senior has no coverage until his or her drug costs reach $5,100-a
gap of $2,850. In 2007, the gap will increase to $3,051, and it is
projected to grow to $5,066 in 2013. While in this coverage gap,
seniors continue to pay Part D premiums.
"Drug plan coverage in the doughnut hole will be much scarcer in
2007, and, in those states where such coverage continues to be
available, it will be far more expensive," said Ron Pollack,
Executive Director of Families USA. "This coverage gap never made
sense, and now it is getting worse for seniors who take multiple
prescription drugs."
In seven upper Midwestern and Mountain-West states (Iowa, Minnesota,
Montana, Nebraska, North Dakota, South Dakota, and Wyoming) that
will still have Part D plans that provide doughnut hole coverage for
the most commonly prescribed drugs, premiums for the lowest- priced
plans will increase by 185 percent, from $38.70 per month to $110.30
per month-annual cost increases from $464.40 to $1,323.60.
Beyond the premium hikes in those seven states, seniors will face
steep premium increases in the following states: New Jersey (179.8
percent), Missouri (111.8 percent), Delaware (95.2 percent), the
District of Columbia (95.2 percent), Maryland (95.2 percent), Kansas
(88.7 percent), Alabama (84.3 percent), and Tennessee (84.3
percent).
According to the report, in 2006, there were approximately 375,000
Medicare beneficiaries in the four states that had no Part D plan
that had doughnut hole coverage for the top medicines prescribed to
seniors. In 2007, with the addition of nine more states, that number
will grow to more than 6.6 million beneficiaries-almost 18 times
more than in 2006.
Of the top 25 drugs prescribed to seniors, 18 have no generic
substitute. As a result, the Families USA report focuses on Part D
stand-alone drug plans that provide doughnut hole coverage for
brand-name as well as generic drugs. The overwhelming majority of
Medicare beneficiaries receiving drug coverage are in the stand-
alone plans because such plans enable seniors to stay in traditional
Medicare so that they can retain their choice of doctors.
Data for the Families USA report were derived from the Centers for
Medicare and Medicaid Services (CMS). In its "Landscape of Plans,"
which is available online at
http://www.medicare.gov , CMS identifies all Part D plans
that provide coverage for all formulary drugs in the doughnut hole
in 2006 and 2007. In states where more than one such plan was
available, Families USA reported on the plan with the lowest monthly
premium for that year.