One study that CVS Caremark conducted with Brigham & Women's Hospital in Boston found that beneficiaries who had to pay the full cost of brand-name medications when they hit the doughnut hole
were twice as likely to stop taking them altogether than to switch to generics.
We conclude that risk-adjusting the doughnut hole
is not just expected to increase incentives for cost containment, but also to reduce the difference in out-of-pocket expenses between the healthy and the chronically ill.
Tavenner: About 8 million Medicare beneficiaries are expected to reach the prescription drug coverage gap that we call the doughnut hole
The one-time $250 rebate checks will be mailed automatically to seniors' homes from Medicare when they enter the doughnut hole
There's no good news for the doughnut hole
The size of this doughnut hole
will grow in the future, since the basic benefit schedule is indexed to average per person drug spending, which is projected to grow at a rate of more than 8 percent annually.
"I think the doughnut hole
is going to come as a shock to seniors who were probably unaware of it," said Ron Pollack, executive director of Families USA, a health care consumer advocacy organization.
Senator Debbie Stabenow will shortly introduce a bill with several co-sponsors, that would restore Medicare's authority to negotiate drug prices and offer a direct Medicare plan that fills in the "doughnut hole
." But Stabenow will count herself lucky if much more than half the Democratic caucus supports her bill.
Many people enjoy dunking their doughnuts in coffee, and Medicare beneficiaries might need more than a few cups when taking in Part D's "doughnut hole
." Judith Stein, JD, executive director and founder of the Center for MedicareAdvocacy, Inc., explains that this doughnut hole
is essentially a second deductible that beneficiaries pay under Part D drug coverage.
Other aspects of the new law that may affect people with HIV/AIDS include: how quickly newly approved drugs will be added to formularies; whether plans will cover off-label uses for drugs (sometimes important for people with HIV/AIDS); whether dual eligibles will face temporary lapses in drug coverage as their drug benefit shifts from Medicaid to Medicare: the gap ("doughnut hole
") in prescription drug coverage for many beneficiaries until their true-out-of-pocket (TrOOP) costs reach catastrophic coverage thresholds; and the uncertain impact of the Medicare drug benefit on ADAPs ...
"We have a huge drug benefit with a huge doughnut hole
in the middle," declares Arrick.
Each chunk of doughnut, whether rigidly straight-edged or organically tubular, should somehow connect or overlap so that a large interesting doughnut hole
of negative space is present in the center of the page.