Autumn is the time of year when many people in Medicare Part D fall into the infamous “doughnut hole.” The doughnut hole is a coverage gap in the Medicare Part D benefit that requires enrollees to pay all their medication costs once they have received $2,700 worth of drugs until their total drug costs reaches approximately $6,100. For some, the added Rx costs are unexpected or unpredictable, and for many, being in the doughnut hole is simply unaffordable.
This year, the doughnut hole need not be as burdensome as before because of a new Doughnut Hole calculator from AARP. This online, interactive tool, available at www.aarp.org/doughnuthole, guides consumers to options for reducing their Part D spending by identifying less costly generic or therapeutically similar alternatives.
Nationally, about one in every four Part D enrollees not enrolled in low-income subsidies, who filled one or more prescriptions in 2007 – some 3.4 million people – fell into the doughnut hole, according to a report from the Kaiser Family Foundation. That same year in North Carolina, a higher percentage – 30 percent - fell into the coverage gap. On average, patients out of pocket spending doubles when they reach the doughnut hole, and 16 percent of the people in the coverage gap report stopping or reducing their medications as a result.
The less expensive medication options generated by the Doughnut Hole Calculator are created using a number of highly scientific sources, such as the Oregon Health and Science University’s Drug Effectiveness Review Project. Users of the calculator do not need to register their personal information, and their medical data are not saved, ensuring privacy.
To use the calculator, go to www.aarp.org/doughnuthole, type in your zip code, select your Part D plan from the list and list the medications you take routinely. The calculator will:
- Show if and when you will fall into the doughnut hole this year;
- Identify up to three different medications that have a similar medical effect as your prescribed drugs but are less expensive;
- Recalculate your out of pocket costs using these drug options and shows if and when you’ll hit the doughnut hole if you switch to the other similar prescription medications; and
- Include a letter that you can bring to your doctor to discuss whether the drug options will work for you.
The process only takes about 15 minutes, requires no registration and is anonymous. Users do not have to give their name or Medicare number. The calculator works with all Part D plans and does not promote any particular one. It does not require that you switch plans in order to save money.
In a related development affecting brand name drugs, , AARP has endorsed an offer by drug manufacturers to contribute some $80 million during the next ten years toward discounting the cost of Medicare prescriptions by 50 percent. The pharmaceutical trade group PhRMA, the Pharmaceutical Researchers and Manufacturers of America, has committed to allowing seniors who fall into the doughnut hole to pay half-price for all brand-name medicines, which could save some 3.5 million retirees up to $1,700 per year. In addition, the full price of the drug – not the discounted price – would count toward an individual’s out of pocket total, thus maximizing the insurance benefit.
If enacted as part of overall health care reform legislation, the PhRMA discount offer for brand name drugs would not take place until 2010, so the AARP Doughnut Hole Calculator will be a valuable tool in suggesting less expensive generic or therapeutically similar medications in the interim and beyond.
