Since the Medicare Part D prescription drug coverage was first implemented in 2004 it has caused nothing but trouble for seniors. This was before today’s terrible economic recession that is hitting many seniors very hard. Congress allowed the lobbying of pharmaceutical companies to corrupt their lawmaking. The result is a gap in drug coverage called the “doughnut hole.”
It comes to this: After a certain amount of money is spent by participants and by their insurance company they no longer pay affordable co-pays, but must pay the full cost of their prescription drugs. And these costs are very high, because the pharmaceutical companies successfully prevented the government from negotiating prices. A typical brand name prescription drug can cost well over $300 for a three month supply, compared to something like a $100 co-pay before the coverage gap.
The problem is that fixed amount of money that is set every year which determines when the coverage gap hits the elderly. That threshold figure was $2,510 in 2008 and rises to $2,700 for 2009. The co-pay figures are deceiving, because the plan provider is paying the normal full cost for drugs and it is the total of what the enrollee and plan provider pay that counts toward the threshold figure.
A person that is using several brand name prescription drugs can find themselves hitting the coverage gap easily within six to nine months of the year’s start. At that point many, many seniors find themselves facing the full, high costs of their drugs, which many can not afford.
The result is that millions of elderly people stop taking their drugs partially or all together.
In 2007 it was found that 26 percent of Part D participants – some 3.4 million people – hit and suffered with the coverage gap. It has been estimated that at least 15 percent of people with chronic illnesses stopped taking their drugs. Faced with many hundreds of dollars per month, there surely will be many more people facing this predicament in 2009 as they face harder economic times. Also, nearly all Part D participants are facing sharp increases in their regular plan costs.
What is needed is major reform of this program by Congress. In the meantime, people caught in this drug coverage trap have a few options. Make sure you are using cut-rate generic drug programs at places like Target, Walmart and Costco, where you can get a three month supply for just $10. Consider buying generic versions of brand name drugs not yet available in the US by using mail order opportunities found on the Internet. For example, the widely used Lipitor and Plavix though not available in generic form in the US are widely available overseas and cost a small fraction of the brand name in the US. Also, consider asking your physician for a higher dose version of your drug so that you can cut the pills in half, making a three month supply last six months.
Finally, pray that President Obama and Congress have the good sense to reform this part of Medicare.