‘Doughnut hole’ hard to swallow; Senior groups are seeking changes to Part D prescription plan

‘Doughnut hole' hard to swallow; Senior groups are seeking changes to Part D prescription plan'

News-Sentinel (Fort Wayne, IN)
By Jennifer L. Boen

The year is not yet half over, but 92-year-old Nick Heiny, has already hit what has been coined the "doughnut hole" in his Medicare Part D prescription drug plan. It means the Fort Wayne man must pay for his medications out of his own pocket for a time, to the tune of about $3,000. A $28 co-pay for his most expensive drug is what he's paid since January, when Part D went into effect. At the end of the month, however, when he goes to the pharmacy for his refill, he'll have to fork over $334 for just one drug.

Heiny was among about 30 people who attended a town hall meeting Thursday on Medicare Part D sponsored by the statewide senior advocacy group United Senior Action and the Indiana Alliance For Retired Americans. The two groups are asking seniors to sign petitions that will be sent to federal legislators requesting changes be made to Part D.

Among the changes they want:

♦Reduce the cost of prescription drugs by requiring Medicare to negotiate lower prices with pharmaceutical companies.

♦Guarantee seniors' right to safely import medicine.

♦Use the savings to provide a comprehensive, stable benefit with no "doughnut hole."

♦Give seniors the choice to obtain prescription drug coverage directly from Medicare; Part D participants must now choose one of many plans all of which are administered by private insurance companies.

Several people at Thursday's meeting said the infamous doughnut hole has caught them off guard. They didn't realize the $2,250 benchmark - the expenditure point after which they must pay 100 percent of their drug costs up to $5,100 - included not just their co-pays but the actual cost of the drugs.

"That's what I thought," Heiny said, noting the doughnut hole came much sooner than he anticipated.

"I'm told by the (Senior Health Insurance Information Program, or SHIIP) office they are getting a substantial number of calls for people who are already in the doughnut hole," said Paul Severance, executive director of United Senior Action. People are unprepared for their pharmacist's words, "‘Sorry, you've got to pay for the whole thing,'" he said.

Jean Lauer said her parents chose a Part D plan that is mail order. They order three months' of drugs at a time, which is a savings. "Now they're getting at the doughnut hole," and they will be paying 100 percent of the cost, "but they can't afford to pay three months at a time at the pharmacy," she said. So it will require a new prescription from the doctor for monthly refills, plus extra co-pays.

Donna Cusick, who helps sign people up for Part D through the Allen County Council on Aging, says the issue of the doughnut hole is, for the most part, the only complaint she is hearing from people.

Only for medications are seniors not allowed to access benefits directly through Medicare, Severance pointed out. Doctor and hospital care and equipment like wheelchairs are available directly through the federal health program.

One of the most problematic issues with Part D, Severance said, is the fact that legislators wrote into the rules that Medicare cannot negotiate with drug companies for lower prices. "Who ever heard of such a thing?" he said, noting that rule flies in the face of how the federal government negotiates lower prescription prices for the VA.

Allowing drug companies to set their own prices comes out of the strong campaign contributions and lobbying by the pharmaceutical industry, Severance said, noting between 1999 and 2004, campaign contributions from drug companies totaled $46.9 million, according to Citizens for Responsible Government. Drugs purchased from Canada or the European Union run one-half or less of U.S.-purchased meds, he said.

Seniors are also not allowed to purchase drugs from outside the United States under Part D. But Nick Heiny and his wife, Dorothy, say they are likely to go back to buying drugs in Canada or Europe, as they have in the past. "If some changes aren't made (to Part D),

"I have a hunch, unless there are some changes, I'll be off the (Part D) plan by the beginning of next year," Heiny said.

Legislators from the area and those running for office were invited to attend the meeting. Sen. Evan Bayh was represented by regional director Hodge Patel who said, Bayh voted against Part D but is now co-sponsoring legislation to permanently eliminate the penalty eligible beneficiaries pay for not signing up by the May 15 deadline. Except for low-income enrollees, a penalty of 1 percent of the average plan premium cost will be added to the lifetime premium cost for every month of delay.

No one for the offices of Sen. Richard Lugar, R-Ind., or Rep. Mark Souder, R-3rd District, attended. Peter Clerken, campaign director for Democrat Tom Hayhurst, who is running for U.S. Congress against Souder in November, said Hayhurst's stand on the Medicare drug plan is, "it doesn't follow the first rule of legislation, which is: Keep it simple. There are too many drug companies and too many plans."