January 8, 2010

Closing the Medicare ‘Doughnut Hole’

During my travels throughout Rhode Island, I have met countless seniors who are frustrated and confused by Medicare’s prescription drug program – Medicare Part D. Specifically, Rhode Islanders are too often blindsided by the Part D coverage gap, or “doughnut hole,” which exposes seniors to the full cost of prescription drugs after yearly drug expenses exceed $2,700. Drug coverage doesn’t resume until they spend $6,154 for the year – an extraordinarily high threshold.

This sudden rise in prescription costs can be devastating to seniors, many of whom live on fixed incomes. No senior should have to choose between taking their medication or keeping the heat on. Unfortunately, I have heard too many of these stories.

Seniors tell me how they are forced to skip doses because they can’t afford a prescription refill. Others struggle to maintain financial independence, as crippling drug costs stretch their limited budget to the breaking point.

I recently heard from Linda, a concerned daughter from Warwick. Linda’s mother suffers from heart disease and emphysema; chronic conditions that require several medications to keep her healthy. Normally, under the Part D benefit, the medication would cost approximately $14 per prescription. When her mother reached the doughnut hole, however, Linda saw the costs skyrocket to $300 to $350. Linda notes, “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.” While her mother eventually made it out of the doughnut hole, Linda will never forget the toll the added financial burden had on her mother’s health and well-being.

One of the most memorable stories I’ve heard comes from a Woonsocket resident named Travis who came to one of my community dinners. His 90-year-old great-grandmother used to live independently in a walk-up apartment in Woonsocket. One day when she went to her pharmacy counter, her pharmacist told her that she was in the “doughnut hole” and had to pay the full cost of her prescriptions. She told Travis that because of this cost burden, she would no longer be able to afford her apartment or live independently. Confronting this choice is tragic – and intolerable in a society as wealthy as ours.

After hearing Travis’ story, I pledged to make closing the prescription drug doughnut hole one of my top priorities in the Senate. Since 2007, I’ve sponsored legislation to accomplish this goal and urged my colleagues to action. During the current debate on health care, I’ve been pressing for this change to be included in the larger reform bill. I’m proud to report that we’re making real progress.

Majority Leader Harry Reid committed to fully closing the Part D coverage gap in the health care bill we send to President Obama. This step would finally fulfill the promise of Medicare, providing seniors the dependable benefits they have every right to expect. For Travis and his great-grandmother, and other seniors struggling to make ends meet, it’s time to seize this opportunity and finally make Medicare Part D whole. I’m going to keep working to ensure we do.

By: Sheldon Whitehouse