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Nov 2008
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Medicare Advantage Plans
'Doughnut Hole' Forces Beneficiaries To End Drug Treatment
Many Medicare beneficiaries enrolled in the prescription drug benefit do not take necessary medications after they reach the "doughnut hole" coverage gap, in which they must cover the full cost of their treatments. 
According to an analysis released by the Kaiser Family Foundation, 26 percent of Medicare beneficiaries who filled any prescriptions under the prescription drug benefit or about 3.4 million, reached the coverage gap in 2007. The analysis also found that 15 percent of Medicare beneficiaries enrolled in the prescription drug benefit who were taking drugs for a variety of chronic diseases did not take their medications after they reached the coverage gap.
Tricia Neuman, a Kaiser Family Foundation vice president and director of the Medicare Policy Project, said, "High drug costs are a barrier, but this is the first time we're seeing it documented so plainly," adding, "This raises concerns about the consequences for people with serious chronic conditions."
Carolyn Clancy, director of the Agency for Healthcare Research & Quality, said, "There is a growing recognition that the doughnut hole is impairing people's access to medications."
Health care policy experts "believe that the next administration will be under pressure to address the doughnut hole.
House Oversight and Government Reform Committee Chairman, Henry Waxman (D-Calif.) wrote a letter to acting Centers for Medicare and Medicaid Services (CMS) Administrator, Kerry Weems, expressing concern for how premium increases for the Medicare prescription drug benefit will affect beneficiaries. Waxman believes that CMS was "misleading" when it stated that during the open enrollment period beginning November 15, beneficiaries would have access to drug plans with lower premiums than the previous year.
In September, CMS said that beneficiaries nationwide would have access to "at least one prescription drug plan with premiums of less than $20 a month," and that "97 percent of beneficiaries enrolled in a stand-alone prescription drug plan will have access to Medicare drug and health plans in 2009 whose premiums would be the same or less than 2008 coverage."
According to data gathered by Waxman's staff, 16.3 million Medicare beneficiaries, including 92 percent of all drug plan members, will pay higher monthly premiums if they stay with the same plan next year. He also stated that in January 2009, average premiums for the drug benefit will increase by 22 percent, from $31.15 to $38.07 per month.