June 17, 2010

Climbing Out of the Doughnut Hole

This week marked the beginning of the end for the dreaded Medicare Part D “doughnut hole,” which hurts an estimated 15,100 Rhode Islanders each year by stripping them of much needed prescription drug coverage. Starting on Thursday, the federal government began distributing checks for $250 to anyone currently in the doughnut hole and lacking prescription drug coverage. And, thanks to this year’s health care reform legislation, the doughnut hole will be closed entirely by the year 2020.

This is great news for Rhode Islanders like Linda, from Warwick, whose mother reached the coverage limit this April. Linda and her mother felt like they had been pushed off a cliff. Medication that normally cost her mother fourteen dollars skyrocketed to three hundred dollars a month when she hit the doughnut hole.

Linda is the primary caretaker for her mother. Shuttling back and forth to the pharmacy and managing the array of medications that treat her mother’s chronic heart disease and emphysema is a full-time job. On a fixed income, Linda’s mother finds it difficult to afford the full cost of her prescription drugs, and often worries how she will make ends meet.

Rhode Islanders are too often blindsided by the doughnut hole, which exposes seniors to the full cost of prescription drugs after yearly drug expenses exceed $2,830. Drug coverage doesn’t resume until they spend $6,440 for the year – a high threshold for seniors on fixed incomes where average Social Security income is around $14,000 per year.

Linda says, “The increased expense placed an enormous strain on my mom financially and personally. I’ve seen her take less of her medication so they’ll last longer, which only makes her feel worse because she’s not taking her medication properly.” Beyond the cost, the stress and uncertainty of falling in and out of the doughnut hole has taken a toll on her and her mother.

The experience of Linda and her mother is, unfortunately, far too common. No senior should have to choose between taking their medication and keeping the lights or the heat on. I made a commitment when I ran for Senate that I would fight to close this coverage gap. Since 2007, I’ve sponsored legislation to accomplish this goal and urged my colleagues to action. During the recent debate on health care, I pressed for this change to be included in the larger reform bill. Thankfully, these efforts were successful.

For the 177,000 Rhode Island seniors on Medicare, health care reform will gradually, over the next ten years, eliminate the doughnut hole for both brand name and generic drugs. The $250 rebates which began this week are the first step. Next year, seniors will receive a 50% discount from pharmaceutical companies on brand name drugs purchased while in the doughnut hole. In 2013, the federal government will begin to pick up a share of those brand name drug costs as well, starting at 7% and increasing to 25% by 2020. Combined with the 50% discount and the standard 25% Part D copay, that means seniors will receive full Part D coverage for brand name drugs by 2020. For generic drugs, the doughnut hole will begin to close in 2011, with the federal government picking up 7% of costs, increasing to 75% by 2020.

Although the $250 rebate will not solve all of the affordability issues facing seniors, it is the beginning of the end of this hazard for Rhode Island seniors.

As the reforms enacted by the health care bill phase in, the Affordable Care Act will fulfill the promise of a reliable prescription drug benefit that seniors deserve, and I am proud that we will finally put an end to the doughnut hole.

By: Senator Sheldon Whitehouse