Health care reform bill tries to fill part of 'doughnut hole'

2010-04-25T22:56:00Z Health care reform bill tries to fill part of 'doughnut hole'By MIKE DENNISON Missoulian State Bureau missoulian.com

HELENA - For the 28,000 Montana senior citizens who hit the "doughnut hole" in Medicare prescription drug coverage, the health reform bill passed by Congress provides some minimal help this year: A $250 check to fill a hole as deep as $3,600.

It may not be much, but it's a start, advocates for the elderly say, for the bills take further steps next year and down the road to reduce the out-of-pocket cost for some seniors who have Medicare coverage for prescription drugs.

Yet the reform measures may be more notable for what they don't do regarding prescription drug prices. Most advocates say the bills didn't do enough to lower drugs' cost, such as allowing the federal government to negotiate directly with manufacturers to lower prices for drugs covered by Medicare.

"We believe ... we should be taking further steps to lower the cost of prescription drugs, such as safe, legal importation, removing the brand-name companies' monopoly on biologic drugs and allowing Medicare to negotiate for lower drug prices," said Stacia Dahl, spokeswoman for AARP-Montana.

AARP is the consumer group whose membership is citizens 50 years or older, including 164,000 in Montana.

Medicare is the government health insurance program that covers about 45 million elderly Americans, including 160,000 Montanans.

The so-called doughnut hole is a gap in Medicare prescription drug coverage that kicks in once you've purchased $2,830 worth of prescription drugs for the year.

Up to that point, Medicare covers about $1,900, or two-thirds, of the cost of the drugs. But for the next $3,610 worth of drugs you buy, there is no coverage at all. You pay full price until you hit that ceiling, after which Medicare covers 95 percent of the cost.

Tobey Schule, the owner of Syke's Pharmacy in Kalispell, said people with heart problems or diabetes can hit the coverage cap pretty easily.

"It can be pretty devastating for them," he said. "We have a lot of low-income customers who use our pharmacy, so we see it more than a lot of pharmacies. ...

"Some patients, even if they hit the doughnut hole, their income is such that they should (be able to pay). But for others, it's deciding whether they take their drugs or eat."

This year, Medicare beneficiaries who hit the doughnut hole will get a one-time check from the feds for $250. Beginning next January, they'll also get a 50 percent discount on brand-name drugs.

Then, over the next nine years, a series of phased-in discounts and benefits will lead to elimination of the doughnut hole, leaving those covered by Medicare with a 25 percent co-pay for all drugs up to the point where they hit the "catastrophic coverage," when Medicare pays

95 percent.

Dahl said AARP, which lobbied hard to address the doughnut hole problem, is pleased that the bills tackled the issue, but acknowledges that more needs to be done.

"Now that health-insurance reform is enacted, AARP will continue our fight to lower prescription drug costs for seniors and all Americans," she said last week.

Missoulian State Bureau reporter Mike Dennison can be reached at 1-800-525-4920 or at mike.dennison@lee.net.

 

Copyright 2015 missoulian.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

No Comments Posted.

Missoulian Civil Dialogue Policy

Civil Dialogue Policy for Commenting on Missoulian.com

We provide this community forum for readers to exchange ideas and opinions on the news of the day. Passionate views, pointed criticism and critical thinking are welcome. Comments can only be submitted by registered users. By posting comments on our site, you are agreeing to the following terms:

Commentary and photos submitted to the Missoulian (Missoulian.com) may be published or distributed in print, electronically or other forms. Opinions expressed in Missoulian.com's comments reflect the opinions of the author, and are not necessarily the opinions of the Missoulian or its parent company. See the Terms of Service and Privacy Policy for more information.

Our guidelines prohibit the solicitation of products or services, the impersonation of another site user, threatening or harassing postings and the use of vulgar, abusive, obscene or sexually oriented language, defamatory or illegal material. You may not post content that degrades others on the basis of gender, race, class, ethnicity, national origin, religion, sexual orientation, disability or other classification. It's fine to criticize ideas, but ad hominem attacks on other site users are prohibited. Users who violate those standards may lose their privileges on missoulian.com.

You may not post copyrighted material from another publication. (Link to it instead, using a headline or very brief excerpt.)

No short policy such as this can spell out all possible instances of material or behavior that we might deem to be a violation of our publishing standards, and we reserve the right to remove any material posted to the site.

Add Comment
You must Login to comment.

Click here to get an account it's free and quick

Search our events calendar