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“Doughnut Hole” Calculator Messaging

Overarching Theme

AARP believes all Americans should have affordable health care choices, including affordable prescription drugs.

Message Points

Health reform must make prescription drugs more affordable for our members – and all Americans.  We must help those with the highest drug costs save money by closing the doughnut hole and lower drug costs by giving people greater access to generics.

• By closing the “doughnut hole,” we can lower out-of-pocket costs for seniors with high drug costs and give them the coverage they’ve been paying for.
• We must end the drug companies’ monopoly on drugs, especially generic biologics used to treat serious diseases such as cancer and multiple sclerosis that can cost up to $10,000 per month.

In 2007, 26 percent of Part D enrollees who filled any prescription—or about 3.4 million people--fell into the “doughnut hole,” the coverage gap where they have to pay all the costs of their prescription drugs.*

• On average, beneficiaries out-of-pocket drug spending doubles when they reach the doughnut hole.  For people who never get out of the doughnut hole, average out of pocket Rx spending nearly doubled from $104 per month prior to the gap to $196 in the gap.  For people who later qualify for catastrophic coverage, average out-of-pocket Rx spending rose from about $200 per month before hitting the doughnut hole to about $400 per month while they are in the doughnut hole.
• Beneficiaries who are over age 75 are much more likely than younger beneficiaries to fall into the doughnut hole.
• 16% of the people in the coverage gap stopped taking medications or reduced their use of important medications after they reached the coverage gap.  Another 5% switched to a different medication.
• Medicare Part D low-income subsidy provides full “doughnut hole” coverage for those below 150 percent of the federal poverty limit ($16,245 for individuals, $21,855 for couples.) [www.aarp.org/quicklink]

Too many Americans can’t afford the medicines they need.

• One in two Americans say someone in their family skipped pills, or postponed or cut back on needed medical care due to the cost of prescription drugs. 
• Nearly 25 percent of Medicare beneficiaries under Part D  who have three or more chronic conditions delayed or did not fill a prescription because of costs – higher than any other insured group of similar beneficiaries.

AARP has developed a calculator to help people on Medicare save on drug costs and avoid the doughnut hole.

• The doughnut hole calculator helps people see if they’re about to reach the coverage gap and helps them find less expensive, but therapeutically similar drugs.
• The less expensive medication options generated by the doughnut hole calculator are created by DestinationRx using a number of scientific sources: The Drug Effectiveness Review Project, Facts and Comparisons, and Micromedex online drug-information databases, peer-reviewed journal articles and national advocacy organizations such as the American Diabetes Association.
• The doughnut hole calculator is easy to use. Just fill in your zip code, list your drugs and your health plan, and you’ll find out how long your coverage will last before you hit the doughnut hole.   You’ll receive a list of less expensive, but equally effective, medications you can discuss with your doctor.  And the calculator helps you take action: You can print a letter to your doctor for each medication alternative that may save you money. Plus any information you provide stays private…in fact, it goes away as soon as you exit the calculator!
• AARP provides free Personal Medication Record forms to help people track their medicines including over-the-counter medication and dietary supplements to help them take responsibility and work with their health care providers to avoid adverse interactions. Personal Medication Record forms can be ordered or downloaded from www.aarp.org/medicationrecord.

Background

What is the Doughnut Hole? From AARP Bulletin: Medicare Part D: In and Out of the Doughnut Hole (http://bulletin.aarp.org/yourhealth/medicare/articles/medicare_part_d__in.html)

• Medicare drug coverage is generally divided into three phases. Depending on your plan, in the first phase (initial coverage period), you may pay a deductible and about 25 percent of your drug costs. In the third phase (catastrophic coverage), you pay about 5 percent. In between these two periods, there is a gap in coverage (commonly called the doughnut hole) when most people must pay 100 percent of their drug costs out of their own pocket.